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General NPI Number Information
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NPI Number | 1548616840
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Entity Type | Organization
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Legal Business Name | ABSOLUTELY DRIVEN MENTAL HEALTH PROVIDER LLC
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 100 VALLEY RD SUITE1
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2200
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Country | US
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Telephone | 201-574-5640
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Fax | 973-783-8777
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Provider Business Mailing Address
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Address Line | 100 VALLEY RD SUITE1
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE PROVIDER
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Name | VALENTINA SOM
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Credential |
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Telephone | 201-574-5640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00453700
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License Number State | NJ
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