Healthcare Provider Details

I. General information

NPI: 1821537093
Provider Name (Legal Business Name): CPC BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 HIGHWAY 35
RED BANK NJ
07701-5920
US

IV. Provider business mailing address

10 INDUSTRIAL WAY E
EATONTOWN NJ
07724-3332
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-2000
  • Fax:
Mailing address:
  • Phone: 732-935-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number202010204
License Number StateNJ

VIII. Authorized Official

Name: STELLA SANTORA
Title or Position: CIO
Credential:
Phone: 732-935-2260