Healthcare Provider Details

I. General information

NPI: 1790282226
Provider Name (Legal Business Name): ASSOCIATES IN MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BERKELEY RD
ORANGE NJ
07050
US

IV. Provider business mailing address

370 BERKELEY RD
ORANGE NJ
07050
US

V. Phone/Fax

Practice location:
  • Phone: 973-677-7979
  • Fax: 973-677-9877
Mailing address:
  • Phone: 973-677-7979
  • Fax: 973-677-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number44SC00354400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARTHA ADEDOYIN
Title or Position: FOUNDER/PRESIDENT CEO
Credential: MA, CSW, CBT, CCT, C
Phone: 973-676-8899