Healthcare Provider Details

I. General information

NPI: 1336070358
Provider Name (Legal Business Name): HAVENBRIDGE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 VALLEY RD UNIT 2747
CLIFTON NJ
07013-1319
US

IV. Provider business mailing address

377 VALLEY RD UNIT 2747
CLIFTON NJ
07013-1319
US

V. Phone/Fax

Practice location:
  • Phone: 201-370-1911
  • Fax:
Mailing address:
  • Phone:
  • 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: SHAQUILLA M TOWNSEND
Title or Position: CEO
Credential:
Phone: 862-232-9180