Healthcare Provider Details

I. General information

NPI: 1205763307
Provider Name (Legal Business Name): CHANGING TIDES PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ALYSSA LN
RED BANK NJ
07701-5264
US

IV. Provider business mailing address

16 ALYSSA LN
RED BANK NJ
07701-5264
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-6993
  • Fax: 833-605-4359
Mailing address:
  • Phone: 732-865-2665
  • Fax: 833-605-4359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES SABATINO
Title or Position: OWNER
Credential: NP
Phone: 732-865-2665