Healthcare Provider Details

I. General information

NPI: 1104392133
Provider Name (Legal Business Name): CPC BEHAVIORAL HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 US HIGHWAY 9
HOWELL NJ
07731-3380
US

IV. Provider business mailing address

10 INDUSTRIAL WAY E STE 108
EATONTOWN NJ
07724-3332
US

V. Phone/Fax

Practice location:
  • Phone: 732-987-8200
  • Fax:
Mailing address:
  • Phone: 732-982-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STELLA SANTORA
Title or Position: VP/CIO
Credential:
Phone: 732-935-2260