Healthcare Provider Details

I. General information

NPI: 1881755973
Provider Name (Legal Business Name): WEST BERGEN MENTAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHESTNUT ST
RIDGEWOOD NJ
07450-2504
US

IV. Provider business mailing address

120 CHESTNUT ST
RIDGEWOOD NJ
07450-2504
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-3550
  • Fax: 201-652-1613
Mailing address:
  • Phone: 201-444-3550
  • Fax: 201-652-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number30111-01
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30111-01
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30111-01
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number30111-01
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number30111-01
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3011101
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3011101
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number30111-01
License Number StateNJ
# 9
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number30111-01
License Number StateNJ

VIII. Authorized Official

Name: MR. MICHAEL TOZZOLLI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW,
Phone: 201-444-3550