Healthcare Provider Details

I. General information

NPI: 1124285911
Provider Name (Legal Business Name): BEHAVIORAL HEALTH AND PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 FRANKLIN CORNER ROAD
LAWRENCEVILLE NJ
08648
US

IV. Provider business mailing address

136 FRANKLIN CORNER ROAD
LAWRENCEVILLE NJ
08648
US

V. Phone/Fax

Practice location:
  • Phone: 609-658-5615
  • Fax: 609-585-4902
Mailing address:
  • Phone:
  • 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 Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS BELL
Title or Position: MANAGER
Credential:
Phone: 609-658-5615