ELYCE JACKSON (NPI# 1942708268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942708268 |
| Entity Type | Individual |
| Full Name | ELYCE JACKSON |
| Practice Address |
10 Industrial Way Eatontown NJ 07724 |
| Mailing Address |
175 E Hawthorn Pkwy Ste 235 Vernon Hills IL 60061-1454 |
| Practice Telephone | 7326733183 |
| Mailing Telephone | 8478683435 |
| Mailing Fax Number | 8478595885 |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2020-03-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
37AC00303100 | NJ | Behavioral Health & Social Service Providers |
| Street Address |
10 INDUSTRIAL WAY |
| City | EATONTOWN |
| State | NJ |
| Zip Code | 07724 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437719788 | Zsanae Lewis | Driver | 1 Main St Unit 401, Eatontown, NJ 07724 | 2019-06-18 |
| 1417419169 | Refocus | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 613 Hope Road, Building 5 and 2, Eatontown, NJ 07724 | 2019-04-02 |
| 1215401575 | Angela Fordham-lewis | Day Training/Habilitation Specialist | 613 Hope Road, Building #2, Eatontown, NJ 07724 | 2019-01-18 |
| 1174094312 | Patti Kousoulis | Counselor | 10 Industrial Way East, Eatontown, NJ 07724 | 2018-12-16 |
| 1649745589 | Jersey Shore Dental Spa LLC | Dentist | 613 Hope Road Building 5, Eatontown, NJ 07724 | 2018-10-08 |
| 1487135448 | A2z Diagnostics LLC | Pathology | 6 Industrial Way W Ste F19, Eatontown, NJ 07724 | 2018-08-27 |
| 1477065894 | The Arc of Monmouth, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 36 Country Club Road Apt. 249, Eatontown, NJ 07724 | 2017-10-25 |
| 1639681059 | The Arc of Monmouth, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 36 Country Club Road Apt. 277, Eatontown, NJ 07724 | 2017-10-25 |
| 1669998100 | Seacrest Recovery Center North Jersey, LLC | Psychologist | 162 Highway 35, Eatontown, NJ 07724 | 2017-08-16 |
| 1265956221 | The Arc of Monmouth, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 36 Country Club Road, Country Club Estates Apt 81, Eatontown, NJ 07724 | 2017-08-01 |
| Find all providers in zip 07724 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215561337 | Deana Alessio | Counselor | 19 Birch Ln, Eatontown, NJ 07724-3469 | 2020-02-27 |
| 1629501440 | Michael Anthony Buccheri | Counselor | 615 Hope Rd Bldg 5b2, Eatontown, NJ 07724-1277 | 2017-04-08 |
| 1881146942 | Brooke Sirota | Counselor | 117 Highway 35 Ste 2, Eatontown, NJ 07724-1886 | 2016-10-25 |
| 1861641169 | Larisa M Citsay | Counselor | 164a Eatoncrest Dr, Eatontown, NJ 07724-1260 | 2008-09-11 |
| 1902052335 | Richard Ponton | Counselor | 56 Jamestown Rd, Eatontown, NJ 07724-2433 | 2008-08-18 |
| 1891834529 | Center for Vocational Rehab | Counselor | 15 Meridian Rd, Eatontown, NJ 07724-2242 | 2007-02-06 |
| 1912519992 | Kaitlyn Gilmartin | Counselor | 117 Highway 35 Ste 2, Eatontown, NJ 07724-1886 | 2020-08-20 |
| 1649896515 | Brianna Pardo | Counselor | 117 Highway 35 Ste 2, Eatontown, NJ 07724-1886 | 2020-06-17 |
| 1811512585 | Malik Biel | Counselor | 117 Highway 35 Ste 2, Eatontown, NJ 07724-1886 | 2020-06-09 |
| 1073132858 | Emmi Mccauley | Counselor | 613 Hope Rd, Eatontown, NJ 07724-1278 | 2020-04-13 |
| Find all providers in EATONTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.