MEDICARE: VA BEHAVIORAL CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1083425805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA BEHAVIORAL CONSULTING LLC

Provider Business Mailing Address
First Line	:	4 BRIGHTON RD STE 400
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07012-1646
Country	:	US
Telephone Number	:	201-581-6622
Fax Number	:	757-530-8212

Provider Business Practice Location Address
First Line	:	4 BRIGHTON RD STE 400
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07012-1646
Country	:	US
Telephone Number	:	201-581-6622
Fax Number	:	757-530-8212

Authorized Official
Title or Position	:	CFO
Name	:	YEHUDA GITTLESON
Credential	:
Telephone Number	:	201-581-6622

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	01/20/2025

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