1821147554 NPI number — MRS. GINA MARIE UNGER LCSW

Table of content: MRS. GINA MARIE UNGER LCSW (NPI 1821147554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821147554 NPI number — MRS. GINA MARIE UNGER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNGER
Provider First Name:
GINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821147554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 PINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR GROVE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07009-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-890-8637
Provider Business Mailing Address Fax Number:
973-860-1326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
562 KINGSLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NUTLEY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07110-1069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-930-5507
Provider Business Practice Location Address Fax Number:
973-860-1326
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC00041300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 053835YHEQ . This is a "GROUP PTAN BURKE AND UNGER LIFEWORKS COUNSELING" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 053835 . This is a "PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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