Organization
ELMLIFELINES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY A BECK LCSW (DIRECTOR)
(609) 654-4044
Entity
Organization
Contact information
Practice address
23 S MAIN ST, MEDFORD, NJ 08055-2444
(609) 654-4044
(609) 953-5060
Mailing address
23 S MAIN ST, MEDFORD, NJ 08055-2444
(609) 654-4044
(609) 953-5060
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
22484
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6913504
—
NJ
Enumeration date
03/28/2007
Last updated
08/22/2020
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