Healthcare Provider Details

I. General information

NPI: 1386001469
Provider Name (Legal Business Name): EXPRESSIONS BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EVERGREEN PL SUITE 709
EAST ORANGE NJ
07018-2011
US

IV. Provider business mailing address

134 EVERGREEN PL SUITE 709
EAST ORANGE NJ
07018-2011
US

V. Phone/Fax

Practice location:
  • Phone: 862-930-3507
  • Fax: 862-930-3482
Mailing address:
  • Phone: 862-930-3507
  • Fax: 862-930-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number44SC05478100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number44SC05478100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number37LC00124200
License Number StateNJ

VIII. Authorized Official

Name: MS. DONNA E SMITH
Title or Position: CEO/FOUNDER
Credential: MSW,LCSW,LCADC
Phone: 973-641-2298