Crossroads Counseling & Psychotherapy, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05300400 Issued in NJ

Legal business name

CROSSROADS COUNSELING & PSYCHOTHERAPY, LLC

Practice address

36 Riverview Ter
Mahwah, NJ 07430-1607

Phone

(201) 694-1648

NPI assigned

Jul 26, 2018

Last updated

Jun 20, 2024By 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

Deborah Rizzo Kourgelis, LCSW, LCADCNPI 1700029477

Title

Owner

Phone

(201) 694-1648

Specialties & licenses 2

Addresses

Locations

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.

• Deborah R. Kourgelis, LCSW

  • Clinical Social Worker
  • Ridgewood, NJ
  • NPI 1700029477
  NPD Authorized official

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1962989442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 RIVERVIEW TER",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074301607",
            "telephone_number": "201-694-1648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 RIVERVIEW TER",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074301607",
            "telephone_number": "201-694-1648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS COUNSELING & PSYCHOTHERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-26",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "KOURGELIS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "RIZZO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-694-1648",
        "authorized_official_credential": "LCSW, LCADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00165200",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05300400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Mahwah, NJ
• Providers in Mahwah, 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 Jun 20, 2024; 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.