Healthcare Provider Details

I. General information

NPI: 1649482506
Provider Name (Legal Business Name): GREATER TRENTON BEHAVIORAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRUNSWICK AVENUE
TRENTON NJ
08638
US

IV. Provider business mailing address

PO BOX 1004
BUCKINGHAM PA
18912-1004
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax:
Mailing address:
  • Phone: 215-794-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number44SC00573700
License Number StateNJ

VIII. Authorized Official

Name: MS. MARIE JONES
Title or Position: CLINICAL SUPERVISOR
Credential: LCSW
Phone: 609-396-8877