Healthcare Provider Details

I. General information

NPI: 1306783709
Provider Name (Legal Business Name): NEW JERSEY COMMUNITY RESOURCE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W MAPLE AVE
BOUND BROOK NJ
08805-1236
US

IV. Provider business mailing address

355 W MAPLE AVE
BOUND BROOK NJ
08805-1236
US

V. Phone/Fax

Practice location:
  • Phone: 732-357-5642
  • Fax: 732-369-3008
Mailing address:
  • Phone: 732-357-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT C ANDERSON
Title or Position: CEO
Credential: PTA, BA
Phone: 732-357-5642