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General NPI Number Information
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NPI Number | 1528881836
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH THERAPEUTIC BEHAVIORAL SUPPORTS & DEV. DIS., LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 81 NORTHFIELD AVE STE 106
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City | WEST ORANGE
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State | NJ
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Zip | 07052-5343
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Country | US
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Telephone | 973-762-2020
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Fax | 973-762-2021
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Provider Business Mailing Address
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Address Line | 60 N WYOMING AVE STE 106
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1526
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Country | US
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Telephone | 973-762-2020
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Fax | 973-762-2021
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Authorized Official
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Title or Position | CEO
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Name | MS. MARTHA TAYLOR
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Credential | MA
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Telephone | 73-762-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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