Provider Demographics
NPI:1710663257
Name:MONARCH COUNSELING CENTER LLC
Entity type:Organization
Organization Name:MONARCH COUNSELING CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-419-4738
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-0495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 SICOMAC RD STE 305
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2954
Practice Address - Country:US
Practice Address - Phone:201-419-4738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1952034647Medicaid