Healthcare Provider Details

I. General information

NPI: 1508353137
Provider Name (Legal Business Name): LITTLE SILVER BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SYCAMORE AVE BLDG 2
LITTLE SILVER NJ
07739-1228
US

IV. Provider business mailing address

34 SYCAMORE AVE BLDG 2
LITTLE SILVER NJ
07739-1228
US

V. Phone/Fax

Practice location:
  • Phone: 732-576-8925
  • Fax: 732-576-8814
Mailing address:
  • Phone: 732-576-8925
  • Fax: 732-576-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00345400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05240800
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID MICHAEL GOLDBERG
Title or Position: PRESIDENT
Credential: PH,D,
Phone: 732-576-8925