Healthcare Provider Details

I. General information

NPI: 1043360266
Provider Name (Legal Business Name): CREATIVE INTERVENTION FOR MENTAL HEALTH AND CHEMICAL DEPENDENCY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 BLOOMFIELD AVE
CLIFTON NJ
07012-2314
US

IV. Provider business mailing address

20 SCOTCH ROAD 3RD FLOOR
EWING NJ
08628-2503
US

V. Phone/Fax

Practice location:
  • Phone: 973-365-2300
  • Fax: 973-365-0868
Mailing address:
  • Phone: 609-406-0100
  • Fax: 609-406-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA GOCHFELD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 609-662-3096