Healthcare Provider Details

I. General information

NPI: 1154188118
Provider Name (Legal Business Name): WTTS PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST
SPARTA NJ
07871-1937
US

IV. Provider business mailing address

25 MAIN ST
SPARTA NJ
07871-1937
US

V. Phone/Fax

Practice location:
  • Phone: 973-903-5431
  • Fax: 973-905-4899
Mailing address:
  • Phone: 973-903-5431
  • Fax: 973-905-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDWARD BLEVINS
Title or Position: OWNER
Credential:
Phone: 908-246-0553