Healthcare Provider Details

I. General information

NPI: 1629856299
Provider Name (Legal Business Name): GREENHOUSE FOR MENTAL HEALTH DEVELOPMENT P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ROUTE 46 W BLDG F
MOUNTAIN LAKES NJ
07046-1668
US

IV. Provider business mailing address

PO BOX 282
MOUNTAIN LAKES NJ
07046-0282
US

V. Phone/Fax

Practice location:
  • Phone: 973-722-0483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AYODELE GREEN
Title or Position: PRESIDENT
Credential: MD
Phone: 973-722-0483