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General NPI Number Information
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NPI Number | 1821560012
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Entity Type | Organization
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Legal Business Name | PA MENTAL HEALTH
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 204 ERIE ST STE 2FL
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City | ELIZABETH
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State | NJ
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Zip | 07206-1569
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Country | US
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Telephone | 908-759-2370
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Fax | 908-469-5817
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Provider Business Mailing Address
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Address Line | 204 ERIE ST STE 2FL
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City | ELIZABETH
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State | NJ
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Zip | 07206-1569
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Country | US
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Telephone | 908-759-2370
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Fax | 908-469-5817
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUN CEO
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Name | MR. MIGUEL A MATOS
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Credential | LPC
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Telephone | 908-759-2376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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