# ST. LUKE'S COUNSELING MEDICAL CENTER L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154888162
- **Authorized official:** DR. JOSEPH G.A. IBRAHIM MD (OWNER)
- **Authorized official phone:** (201) 779-3320

## Contact information

- **Practice address:** 59 SEELEY AVE, KEARNY, NJ 07032-3120
- **Practice address phone:** (201) 428-1040
- **Practice address fax:** (201) 428-1161
- **Mailing address:** 59 SEELEY AVE, KEARNY, NJ 07032-3120
- **Mailing address phone:** (201) 428-1040
- **Mailing address fax:** (201) 428-1161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/26/2019
- **Last updated:** 02/26/2019