Healthcare Provider Details

I. General information

NPI: 1497253553
Provider Name (Legal Business Name): CPC BEHAVIORAL HEATHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
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
EATONTOWN NJ
07724-3332
US

V. Phone/Fax

Practice location:
  • Phone: 732-987-8200
  • Fax: 732-389-3207
Mailing address:
  • Phone: 732-935-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number202010504
License Number StateNJ

VIII. Authorized Official

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