Community Counseling Service of South Jersey LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

COMMUNITY COUNSELING SERVICE OF SOUTH JERSEY LLC

Practice address

121 W Centennial Dr
Medford, NJ 08055-8136

Phone

(856) 596-6444

Fax

(856) 797-8512

NPI assigned

Jan 31, 2013

Last updated

Jan 31, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karen Ann Brook, LCSWNPI 1013076132

Title

President

Phone

(856) 596-6444

Specialties & licenses 2

Addresses

Other names 1

• Karen Ann Brook LCSW Other name

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Karen Ann Brook, LCSW

  • Mental Health Counselor
  • Medford, NJ
  • NPI 1013076132
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359590400000",
    "number": "1356680003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W CENTENNIAL DR",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558136",
            "telephone_number": "856-596-6444",
            "fax_number": "856-797-8512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W CENTENNIAL DR",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558136",
            "telephone_number": "856-596-6444",
            "fax_number": "856-797-8512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY COUNSELING SERVICE OF SOUTH JERSEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-31",
        "last_updated": "2013-01-31",
        "status": "A",
        "authorized_official_last_name": "BROOK",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-596-6444",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Karen Ann Brook LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Wanda I Coss, MD

• Clinical Social Worker in Medford, NJ
• Providers in Medford, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.