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General NPI Number Information
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NPI Number | 1578968673
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Entity Type | Organization
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Legal Business Name | CEREBRAL PALSY OF NORTH JERSEY
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 220 S ORANGE AVE SUITE 300
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5804
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Country | US
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Telephone | 973-763-9900
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Fax | 973-488-6223
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Provider Business Mailing Address
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Address Line | 220 S ORANGE AVE SUITE 300
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5804
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Country | US
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Telephone | 973-763-9900
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Fax | 973-488-6223
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Authorized Official
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Title or Position | ICAN PROGRAM DIRECTOR
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Name | MRS. ALLISON TYLER
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Credential | LCSW
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Telephone | 973-763-9900
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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 | 40QA01001600
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License Number State | NJ
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