Healthcare Provider Details

I. General information

NPI: 1750137881
Provider Name (Legal Business Name): BAKER STREET MIND HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 FRANKLIN LAKE RD STE 204
FRANKLIN LAKES NJ
07417-2267
US

IV. Provider business mailing address

851 FRANKLIN LAKE RD STE 204
FRANKLIN LAKES NJ
07417-2267
US

V. Phone/Fax

Practice location:
  • Phone: 201-381-6136
  • Fax:
Mailing address:
  • Phone: 201-381-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL FARBER
Title or Position: CMO
Credential: MD
Phone: 201-381-6136