Healthcare Provider Details

I. General information

NPI: 1104062512
Provider Name (Legal Business Name): THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WOODLANE RD SUITE #301
WESTAMPTON NJ
08060-3832
US

IV. Provider business mailing address

1289 ROUTE 38 SUITE #203
HAINESPORT NJ
08036-2730
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5656
  • Fax:
Mailing address:
  • Phone: 609-267-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number402020604
License Number StateNJ

VIII. Authorized Official

Name: MR. HARRY MARMORSTEIN
Title or Position: CEO
Credential:
Phone: 609-267-5656