Tides of Change Counseling

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

TIDES OF CHANGE COUNSELING

Practice address

67 Apple St
Tinton Falls, NJ 07724-2636

Phone

(603) 361-6402

NPI assigned

Dec 19, 2022

Last updated

Dec 19, 2022By 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

Kristine LaneNPI 1518698554

Title

Owner

Phone

(603) 361-6402

Specialties & licenses 1

Addresses

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.

• Kristine Lane, LCSW

  • Clinical Social Worker
  • Tinton Falls, NJ
  • NPI 1518698554
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1508578717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8502",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077018502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 APPLE ST",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077242636",
            "telephone_number": "603-361-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDES OF CHANGE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-19",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-361-6402"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Tinton Falls, NJ
• Providers in Tinton Falls, 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 Dec 19, 2022; 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.