Healthcare Provider Details

I. General information

NPI: 1871921346
Provider Name (Legal Business Name): BLUE HOPE SUPPORTIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NESBIT TER
IRVINGTON NJ
07111-1773
US

IV. Provider business mailing address

260 NESBIT TER
IRVINGTON NJ
07111-1773
US

V. Phone/Fax

Practice location:
  • Phone: 973-868-9640
  • Fax:
Mailing address:
  • Phone: 973-868-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHARMY PIERRE-LOUIS
Title or Position: MANAGING MEMBER
Credential: LAC
Phone: 973-868-9640