Healthcare Provider Details

I. General information

NPI: 1699958504
Provider Name (Legal Business Name): GREATER TRENTON BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRUNSWICK AVE 2ND FLOOR
TRENTON NJ
08638-3829
US

IV. Provider business mailing address

1001 SPRUCE ST SUITE 205
EWING NJ
08638-3957
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax: 609-396-6024
Mailing address:
  • Phone: 609-396-6788
  • Fax: 609-989-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number44SC05275000
License Number StateNJ

VIII. Authorized Official

Name: MS. CAROLINE A WASHINGTON
Title or Position: CLINICIAN
Credential: MSW, LCSW
Phone: 609-396-4258