=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386183101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIQUE BEHAVIORAL & MENTAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2017
-----------------------------------------------------
Last Update Date | 02/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 W BLACKWELL ST STE 201D
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07801-3996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-620-9196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 WEST BLACKWELL STREET UNIT 201D
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-620-9196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PHILOMINA/AZUKA IGWECHI/OFODIKE
-----------------------------------------------------
Credential | APN
-----------------------------------------------------
Telephone | 973-620-9196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 26NJ00477000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 26NJ00508400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------