Healthcare Provider Details

I. General information

NPI: 1285953976
Provider Name (Legal Business Name): PINNICLE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 ROUTE 88 SUITE E8
POINT PLEASANT NJ
08742-2871
US

IV. Provider business mailing address

2911 ROUTE 88 SUITE E8
POINT PLEASANT NJ
08742-2871
US

V. Phone/Fax

Practice location:
  • Phone: 732-295-1008
  • Fax: 732-899-5733
Mailing address:
  • Phone: 732-295-1008
  • Fax: 732-899-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number25MA07322300
License Number StateNJ

VIII. Authorized Official

Name: JAYANTHI PERIASAMY
Title or Position: DOCTOR
Credential: M.D.
Phone: 732-295-1008