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NPI Code Detail

MEDICARE: ADVANCED BEHAVIORAL HEALTH

MEDICARE: ADVANCED BEHAVIORAL HEALTH
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
1104100000XSocial Worker
2363L00000XNurse Practitioner
3103T00000XPsychologist

General Provider Information

NPI Number : 1952570558
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : 681 RIVER AVE STE 2E
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-5229
Country : US
Telephone Number : 732-901-0035
Fax Number : 732-905-9891
Provider Business Practice Location Address
First Line : 2109 RED LION RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-1711
Country : US
Telephone Number : 732-901-0035
Fax Number : 732-905-9891
Authorized Official
Title or Position : OWNER
Name : ISSAC S GELLEY
Credential :
Telephone Number : 732-901-0035
Provider Enumeration Date : 02/27/2008
Last Update Date : 06/04/2008

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Directions to “ADVANCED BEHAVIORAL HEALTH ” Practice Location

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