NPIMap

Organization Active NPI

Counseling Center at Fair Lawn, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fair Lawn, NJ
National Provider Identifier
1407276975
Registry record updated Apr 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
2000502 Issued in NJ
Legal business name
COUNSELING CENTER AT FAIR LAWN, LLC
Practice address
16-01 Broadway
Fair Lawn, NJ 07410-2026
Phone
(732) 431-5300
NPI assigned
Apr 23, 2014
Last updated
Apr 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2014

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

Authorized official

Name
Ms. Linda R Burns, RN
Title
Chief Nursing Officer
Phone
(561) 951-8341

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 2000502 NJ Primary

Addresses

Primary practice location

16-01 Broadway
Fair Lawn, NJ 07410-2026

Mailing address

2328 10TH Ave N
Lake Worth, FL 33461-6606
Phone (561) 318-4411

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230208000502 NJ Part B Supplier - Clinic/Group Practice 5496127086 Receives reassigned benefits from 26 practitioners
Practice locations: Fair Lawn, NJ

National Provider Directory

National Provider Directory

Locations

2328 10th Ave N
Ste 300
Lake Worth Beach, FL 33461
Phone (561) 318-4476

16-01 Broadway
Fair Lawn, NJ 07410
Phone (201) 389-5326

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1398211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398211200000",
    "number": "1407276975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2328 10TH AVE N",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334616606",
            "telephone_number": "561-318-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16-01 BROADWAY",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074102026",
            "telephone_number": "732-431-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNSELING CENTER AT FAIR LAWN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-23",
        "last_updated": "2014-04-23",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "561-951-8341",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NJ",
            "license": "2000502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Lawn, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; 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.