Healthcare Provider Details

I. General information

NPI: 1164542718
Provider Name (Legal Business Name): REGROUP BEHAVIORAL HEALTH SERVICES,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 PARK AVE SUITE 7
PLAINFIELD NJ
07060-3253
US

IV. Provider business mailing address

PO BOX 512
FANWOOD NJ
07023-0512
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-3392
  • Fax: 908-755-4768
Mailing address:
  • Phone: 908-755-3392
  • Fax: 908-755-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PRINCETTA A EDWARDS
Title or Position: PSYCHOTHERAPIST PRESIDENT
Credential: LCSW
Phone: 908-755-3392