Lakeside Recovery Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

2000527-11 Issued in NJ

Legal business name

LAKESIDE RECOVERY CENTER

Practice address

200 Independence Blvd
Sicklerville, NJ 08081-1092

Phone

(856) 302-1362

NPI assigned

Jan 10, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Phyllis Weinstein, MSW,MED,LCSW,LPC,LCA

Title

Dir of Treatment Service

Phone

(856) 302-1362

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381708800000",
    "number": "1750651568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 INDEPENDENCE BLVD",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080811092",
            "telephone_number": "856-302-1362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 INDEPENDENCE BLVD",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080811092",
            "telephone_number": "856-302-1362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-10",
        "last_updated": "2013-10-14",
        "status": "A",
        "authorized_official_last_name": "WEINSTEIN",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "DIR OF TREATMENT SERVICE",
        "authorized_official_telephone_number": "856-302-1362",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW,MED,LCSW,LPC,LCA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NJ",
            "license": "2000527-11",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Nicole Krumenacker, PHARMD
• Rochelle Theresa Kugler, RPH
• Lactation Goddess
• Angela Ladson
• Lakeside Internal Medicine Associates,LLC
• Elaine Gail Lange, R.N, A.P.N.
• Melissa Tabitha Laster
• Wisdom Afangide Lawal Sr.
• Andrea J Leach, LCSW
• Lean on We Home Health Care Services LLC

• Clinic/Center in Sicklerville, NJ
• Providers in Sicklerville, NJ by specialty
• Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.