Healthcare Provider Details

I. General information

NPI: 1336217421
Provider Name (Legal Business Name): GREATER TRENTON CMHC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SPRUCE ST SUITE 205
TRENTON NJ
08638-3957
US

IV. Provider business mailing address

PO BOX 1393
TRENTON NJ
08607-1393
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-6788
  • Fax: 609-989-1245
Mailing address:
  • Phone: 609-396-6788
  • Fax: 609-989-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number103040909
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number103040105
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number103040603
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number103040104
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number103040704
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN MONAHAN
Title or Position: PRESIDENT & CEO
Credential: LCSW
Phone: 609-396-6788