Healthcare Provider Details

I. General information

NPI: 1164821138
Provider Name (Legal Business Name): CPC BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
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

270 HIGHWAY 35
RED BANK NJ
07701-5920
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2000332
License Number StateNJ

VIII. Authorized Official

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