Provider Demographics
NPI:1134256712
Name:CHILDREN'S CONTINUUM OF CARE
Entity type:Organization
Organization Name:CHILDREN'S CONTINUUM OF CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:856-661-1100
Mailing Address - Street 1:177 S CENTRE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2220
Mailing Address - Country:US
Mailing Address - Phone:856-661-1100
Mailing Address - Fax:856-661-0910
Practice Address - Street 1:177 S CENTRE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2220
Practice Address - Country:US
Practice Address - Phone:856-661-1100
Practice Address - Fax:856-661-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00158500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0098965Medicaid