Healthcare Provider Details

I. General information

NPI: 1104969096
Provider Name (Legal Business Name): NLP BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VILLAGE CENTER DR SUITE #7047
FREEHOLD NJ
07728-3197
US

IV. Provider business mailing address

PO BOX 7047
FREEHOLD NJ
07728-7047
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-8075
  • Fax: 732-431-0307
Mailing address:
  • Phone: 732-431-8075
  • Fax: 732-431-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA06315000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMA06315000
License Number StateNJ

VIII. Authorized Official

Name: EDUARDO PIETRI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 732-431-8075