Healthcare Provider Details

I. General information

NPI: 1871872226
Provider Name (Legal Business Name): SAMMARET BEHAVIORAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MILLBURN AVE SUITE 210
MILLBURN NJ
07041-1737
US

IV. Provider business mailing address

52 COMMONWEALTH AVE
NEWARK NJ
07106-3027
US

V. Phone/Fax

Practice location:
  • Phone: 973-494-4614
  • Fax:
Mailing address:
  • Phone: 973-494-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number25MA08841500
License Number StateNJ

VIII. Authorized Official

Name: DR. YETUNDE ADEOLA
Title or Position: PSYCHIATRIST
Credential: M.D
Phone: 973-494-4614