Healthcare Provider Details

I. General information

NPI: 1982238184
Provider Name (Legal Business Name): TMR MENTAL HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 09/06/2023
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 MAIN ST STE 1
HACKENSACK NJ
07601-4907
US

IV. Provider business mailing address

PO BOX 924
MAYWOOD NJ
07607-0924
US

V. Phone/Fax

Practice location:
  • Phone: 551-404-9677
  • Fax: 800-322-3738
Mailing address:
  • Phone: 201-528-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
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: TASIA MILICEVIC
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 201-528-5757