Healthcare Provider Details

I. General information

NPI: 1720737745
Provider Name (Legal Business Name): ADVANCED BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 MANTUA BLVD STE 201
SEWELL NJ
08080-1032
US

IV. Provider business mailing address

PO BOX 236
WENONAH NJ
08090-0236
US

V. Phone/Fax

Practice location:
  • Phone: 856-625-9194
  • Fax: 856-644-4599
Mailing address:
  • Phone: 856-625-9194
  • Fax: 856-644-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LALI BINDER
Title or Position: THERAPIST, CEO
Credential: LPC
Phone: 856-625-9194