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General NPI Number Information
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NPI Number | 1447498084
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Entity Type | Organization
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Legal Business Name | MATRIX CLINICAL SERVICES
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 1632 ROUTE 38 STE. A
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City | LUMBERTON
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State | NJ
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Zip | 08048-2923
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Country | US
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Telephone | 609-702-5884
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Fax | 609-702-5882
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Provider Business Mailing Address
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Address Line | 1632 ROUTE 38 STE. A
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City | LUMBERTON
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State | NJ
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Zip | 08048-2923
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Country | US
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Telephone | 609-702-5884
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Fax | 609-702-5882
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Authorized Official
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Title or Position | OWNER
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Name | BEVLIN REGENIA DUNCAN
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Credential | PMHNP-BC
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Telephone | 609-702-5884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 26NJ00141700
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License Number State | NJ
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