Healthcare Provider Details

I. General information

NPI: 1770052540
Provider Name (Legal Business Name): ASSOCIATES IN MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 NORTHFIELD AVE STE 106
WEST ORANGE NJ
07052-5343
US

IV. Provider business mailing address

60 N WYOMING AVE
SOUTH ORANGE NJ
07079-1526
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-8899
  • Fax:
Mailing address:
  • Phone: 973-676-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MARTHA K ADEDOYIN
Title or Position: CEO
Credential: MA, CSW, CBT, CCSP
Phone: 973-676-8899