Healthcare Provider Details

I. General information

NPI: 1932505138
Provider Name (Legal Business Name): ALLIED MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2014
Last Update Date: 11/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CLINTON ST STE L
NEWARK NJ
07102-9713
US

IV. Provider business mailing address

1331 AIRPORT DR G17
TALLAHASSEE FL
32304-4775
US

V. Phone/Fax

Practice location:
  • Phone: 917-364-3785
  • Fax:
Mailing address:
  • Phone: 917-364-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberMH11779
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number37PC00510200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37PC00510200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH 11779
License Number StateFL

VIII. Authorized Official

Name: STEPHANIE LYNN FLEMING
Title or Position: CLINICAL THERAPIST
Credential: PHD,LMHC, LPC
Phone: 917-364-3785