MEDICARE: PREFERRED BEHAVIORAL HEALTH OF NJ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	20302-17-04	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	526788	OTHER	NJ	GROUP MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598999666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED BEHAVIORAL HEALTH OF NJ

Provider Business Mailing Address
First Line	:	PO BOX 2036
Second Line	:	IOTSS PROGRAM
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-8036
Country	:	US
Telephone Number	:	732-367-8859
Fax Number	:	732-364-8242

Provider Business Practice Location Address
First Line	:	725 AIRPORT RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5968
Country	:	US
Telephone Number	:	732-367-8859
Fax Number	:	732-367-8859

Authorized Official
Title or Position	:	CAO
Name	:	JULIE VANORE
Credential	:
Telephone Number	:	732-458-1700

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	03/06/2019

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1457418717 — PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC.
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Practice Location Address:

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08701-5968

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Practice Location Address:

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1053790519 — LADACIN NETWORK
Practice Location Address:

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Practice Fax:

Directions to “PREFERRED BEHAVIORAL HEALTH OF NJ ” Practice Location

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