Healthcare Provider Details

I. General information

NPI: 1871314385
Provider Name (Legal Business Name): COLLABORATIVE SUPPORT PROGRAM OF NEW JERSEY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SPRING ST
FREEHOLD NJ
07728-1843
US

IV. Provider business mailing address

11 SPRING ST
FREEHOLD NJ
07728-1843
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-1175
  • Fax: 732-780-8977
Mailing address:
  • Phone: 732-780-1175
  • Fax: 732-780-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN M. BLACKBURN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 732-414-0081