Integrated Care Consulting LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

INTEGRATED CARE CONSULTING LLC

Practice address

615 Hope Road, BLDG 5B, 2ND Floor
Eatontown, NJ 07724-1277

Phone

(732) 389-0697

Fax

(732) 389-0611

NPI assigned

Sep 19, 2017

Last updated

Mar 15, 2023By 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

Elena Hammer

Title

Billing Manager

Phone

(732) 389-0697

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 7

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.

• John Larry Thompson, LCSW

  • Clinical Social Worker
  • Eatontown, NJ
  • NPI 1538285911
  Medicare reassignment
• Seth A Arkush

  • Clinical Social Worker
  • Eatontown, NJ
  • NPI 1760812051
  NPD (past)
• Simone Nimtzovitch Borger

  • Professional Counselor
  • Tinton Falls, NJ
  • NPI 1538008313
  NPD (past)
• Dana Delfino

  • Mental Health Counselor
  • Tinton Falls, NJ
  • NPI 1396551396
  NPD (past)
• Barbara Ellen Dougherty, LCSW

  • Clinical Social Worker
  • Eatontown, NJ
  • NPI 1386449106
  NPD (past)
• Samantha T Scully

  • Counselor
  • Eatontown, NJ
  • NPI 1093694267
  NPD (past)
• Alexis Sideris

  • Mental Health Counselor
  • Tinton Falls, NJ
  • NPI 1851106637
  NPD (past)

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

{
    "created_epoch": "1505779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678838400000",
    "number": "1811416019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 LIGHTHOUSE DR",
            "city": "WARETOWN",
            "state": "NJ",
            "postal_code": "087582015",
            "telephone_number": "732-389-0697",
            "fax_number": "732-389-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 HOPE ROAD, BLDG 5B, 2ND FLOOR",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077241277",
            "telephone_number": "732-389-0697",
            "fax_number": "732-389-0611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19 N County Line Rd",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "NJ",
            "postal_code": "085271466",
            "country_code": "US",
            "telephone_number": "732-389-0697",
            "fax_number": "732-389-0611",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18 Kings Hwy Ste 206",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "NJ",
            "postal_code": "077482509",
            "country_code": "US",
            "telephone_number": "732-389-0697",
            "fax_number": "732-389-0611",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8 Hillside Ave Ste 108-6",
            "address_purpose": "LOCATION",
            "city": "Montclair",
            "state": "NJ",
            "postal_code": "070422129",
            "country_code": "US",
            "telephone_number": "732-389-0697",
            "fax_number": "732-389-0611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATED CARE CONSULTING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-19",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "HAMMER",
        "authorized_official_first_name": "ELENA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "732-389-0697"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWNER'S INDIVIDUAL NPI",
            "identifier": "1538285911",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNER'S INDIVIDUAL NPI",
            "identifier": "1760812051",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adolescent and Children Mental Health Clinic/Center in Eatontown, NJ
• Providers in Eatontown, NJ by specialty
• Adolescent and Children Mental Health Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.