NPIMap

Organization Active NPI

CCC Counseling Inc

  • Community/Behavioral Health Agency
  • Lakewood, NJ
National Provider Identifier
1366848582
Registry record updated Feb 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CCC COUNSELING INC
Practice address
1212 Todd CT
Lakewood, NJ 08701-2256
Phone
(609) 225-9355
NPI assigned
Nov 16, 2014
Last updated
Feb 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2023

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

Authorized official

Name
Jediedjah Moshe Rodrigues Pereira, MSW, LCSW, LCADC
Title
Owner
Phone
(732) 814-4648

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

1212 Todd CT
Lakewood, NJ 08701-2256

Mailing address

1212 Todd CT
Lakewood, NJ 08701-2256
Phone (732) 814-4648

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210908000435 NJ Part B Supplier - Clinic/Group Practice 3870999493 Receives reassigned benefits from 12 practitioners
Practice locations: Wall Township, NJ; Little Silver, NJ; Linwood, NJ; Lakewood, NJ; Lanoka Harbor, NJ; Colts Neck, NJ

National Provider Directory

National Provider Directory

Locations

317 State Route 34
Ste 121B
Colts Neck, NJ 07722
Phone (732) 242-7393

500 Main St
Ste 5
Lanoka Harbor, NJ 08734

1401 New Rd
Fl 2
Linwood, NJ 08221
Phone (609) 225-9355

34 Sycamore Ave
Ste 2G
Little Silver, NJ 07739
Phone (732) 614-1608

1924 State Route 35
Ste 10A
Wall Township, NJ 07719
Phone (732) 481-4743

1924 State Route 35
Ste 10B
Wall Township, NJ 07719
Phone (732) 814-4648

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1416096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677369600000",
    "number": "1366848582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 TODD CT",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087012256",
            "telephone_number": "732-814-4648",
            "fax_number": "609-228-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 TODD CT",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087012256",
            "telephone_number": "609-225-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCC COUNSELING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-16",
        "last_updated": "2023-02-26",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "PEREIRA",
        "authorized_official_first_name": "JEDIEDJAH",
        "authorized_official_middle_name": "MOSHE RODRIGUES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-814-4648",
        "authorized_official_credential": "MSW, LCSW, LCADC"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2023; 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.