Healthcare Provider Details

I. General information

NPI: 1669408274
Provider Name (Legal Business Name): VERICARE BEHAVIORAL HEALTH OF NEW JERSEY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 VIEWRIDGE AVE STE 230
SAN DIEGO CA
92123-1680
US

IV. Provider business mailing address

4715 VIEWRIDGE AVE SUITE 230
SAN DIEGO CA
92123-1680
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-8715
  • Fax: 858-874-8212
Mailing address:
  • Phone: 800-257-8715
  • Fax: 858-874-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. BENNETT O. VOIT
Title or Position: SECRETARY
Credential:
Phone: 800-257-8715