Healthcare Provider Details

I. General information

NPI: 1962992917
Provider Name (Legal Business Name): SOLUTION BASED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 VALLEY ST APT C
VAUXHALL NJ
07088-1258
US

IV. Provider business mailing address

839 VALLEY ST APT C
VAUXHALL NJ
07088-1258
US

V. Phone/Fax

Practice location:
  • Phone: 973-789-4466
  • Fax:
Mailing address:
  • Phone: 973-789-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PETERSON PIERRE-PAUL
Title or Position: LLC MEMBER
Credential: LCSW
Phone: 973-789-4466