Healthcare Provider Details

I. General information

NPI: 1639696834
Provider Name (Legal Business Name): DEVELOPMENTAL DISABILITIES HEALTH ALLIANCE , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 BROAD ST
BLOOMFIELD NJ
07003-3045
US

IV. Provider business mailing address

1285 BROAD ST
BLOOMFIELD NJ
07003-3045
US

V. Phone/Fax

Practice location:
  • Phone: 973-338-4200
  • Fax: 973-338-4440
Mailing address:
  • Phone: 973-338-4200
  • Fax: 973-338-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CYNTHIA S SOFTY
Title or Position: CONTROLLER
Credential:
Phone: 973-338-4200