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General NPI Number Information
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NPI Number | 1295237212
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Entity Type | Organization
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Legal Business Name | PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 1200 RIVER AVE STE 9D
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5657
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Country | US
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Telephone | 732-901-5106
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Fax | 732-905-9231
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Provider Business Mailing Address
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Address Line | PO BOX 2036
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City | LAKEWOOD
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State | NJ
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Zip | 08701-8036
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Country | US
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Telephone | 732-901-5106
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Fax | 732-905-9231
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Authorized Official
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Title or Position | CAO
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Name | JULIE VANORE
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Credential |
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Telephone | 732-458-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 203021804
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License Number State | NJ
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