Healthcare Provider Details

I. General information

NPI: 1285864850
Provider Name (Legal Business Name): SAINT CLARE'S HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MORRIS AVE
DENVILLE NJ
07834-1735
US

IV. Provider business mailing address

50 MORRIS AVE
DENVILLE NJ
07834-1735
US

V. Phone/Fax

Practice location:
  • Phone: 973-625-7029
  • Fax:
Mailing address:
  • Phone: 973-625-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number37LC00118700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number44SL05263400
License Number StateNJ

VIII. Authorized Official

Name: MR. KERLIN CASADO
Title or Position: CLINICIAN
Credential: LCADC, LSW
Phone: 973-625-7029