Healthcare Provider Details

I. General information

NPI: 1326312018
Provider Name (Legal Business Name): SUMMITT BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 QUAKERBRIDGE RD SUITE 102
PRINCETON JUNCTION NJ
08550-5243
US

IV. Provider business mailing address

4065 QUAKERBRIDGE ROAD SUITE 102
PRINCETON JUNCTION NJ
08550
US

V. Phone/Fax

Practice location:
  • Phone: 609-482-3701
  • Fax: 609-482-3702
Mailing address:
  • Phone: 609-482-3701
  • Fax: 609-482-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY NAOMI
Title or Position: ADMIN
Credential:
Phone: 609-613-2226