Healthcare Provider Details

I. General information

NPI: 1417569013
Provider Name (Legal Business Name): JUVO BEHAVIORAL HEALTH OF WASHINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ STE 500
HACKENSACK NJ
07601-6203
US

IV. Provider business mailing address

1 UNIVERSITY PLZ STE 500
HACKENSACK NJ
07601-6203
US

V. Phone/Fax

Practice location:
  • Phone: 201-470-5754
  • Fax:
Mailing address:
  • Phone: 201-470-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BENJAMIN M KLEIN
Title or Position: MANAGER
Credential:
Phone: 201-470-5751