Healthcare Provider Details

I. General information

NPI: 1528501335
Provider Name (Legal Business Name): MENTAL HEALTH ASSOCIATION IN PASSAIC COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CLIFTON AVE.
CLIFTON NJ
07011
US

IV. Provider business mailing address

404 CLIFTON AVE
CLIFTON NJ
07011
US

V. Phone/Fax

Practice location:
  • Phone: 973-478-4444
  • Fax: 973-478-0941
Mailing address:
  • Phone: 973-478-4444
  • Fax: 973-478-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number101080104
License Number StateNJ

VIII. Authorized Official

Name: MS. REBEKAH LEON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-478-4444