Healthcare Provider Details

I. General information

NPI: 1356588719
Provider Name (Legal Business Name): BANYAN TREE MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19A DELLWOOD LANE
SOMERSET NJ
08873
US

IV. Provider business mailing address

PO BOX 6776
EAST BRUNSWICK NJ
08816-6776
US

V. Phone/Fax

Practice location:
  • Phone: 732-247-9505
  • Fax: 973-324-3641
Mailing address:
  • Phone: 732-247-9505
  • Fax: 973-324-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number35S100391200
License Number StateNJ

VIII. Authorized Official

Name: DR. LORAN C. VOCATURO
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: EDD, ABPP
Phone: 732-735-3925