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General NPI Number Information
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NPI Number | 1831324839
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Entity Type | Organization
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Legal Business Name | WILLOW BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 06/01/2009
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Provider Practice Location Address
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Address Line | 136 FRANKLIN CORNER RD UNIT B, SUITE 101
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2502
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Country | US
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Telephone | 609-613-2226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | HOLICONG
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State | PA
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Zip | 18928-0236
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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 | LCSW
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Name | MARY PUSCHEL
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Credential |
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Telephone | 609-613-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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