Release of Information

  • Advanced Behavioral Counseling of Northern NJ, LLC
    55 Newton-Sparta Road, Suite 103/104, Newton, NJ 07860
    Tel: (973) 579-9394 Fax: (973) 579-9392
    NPI: 1184878449
  • AUTHORIZATION FOR RELEASE OF INFORMATION

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  • The following information with:

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  • Clear Signature
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  • The authorization will expire upon request to revoke in writing at any time, except for an emergency or to the extent that action has already been taken or when treatment is terminated.

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