Healthcare Provider Details

I. General information

NPI: 1790614493
Provider Name (Legal Business Name): SERV BEHAVIORAL HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BLOOMFIELD AVE
CLIFTON NJ
07012-1242
US

IV. Provider business mailing address

777 BLOOMFIELD AVE
CLIFTON NJ
07012-1242
US

V. Phone/Fax

Practice location:
  • Phone: 973-594-0125
  • Fax:
Mailing address:
  • Phone: 973-594-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROSARIO REVERON
Title or Position: CLINICIAN
Credential: LPC
Phone: 973-437-6288