=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962992917
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLUTION BASED SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2018
-----------------------------------------------------
Last Update Date | 05/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 839 VALLEY ST APT C
-----------------------------------------------------
City | VAUXHALL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07088-1258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-789-4466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 839 VALLEY ST APT C
-----------------------------------------------------
City | VAUXHALL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07088-1258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-789-4466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LLC MEMBER
-----------------------------------------------------
Name | MR. PETERSON PIERRE-PAUL
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 973-789-4466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------