MEDICARE: BLUE STAR MENTAL HEALTH SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1295625556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE STAR MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1 BETHANY RD BUILDING 1 STE 7
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1659
Country	:	US
Telephone Number	:	732-705-6266
Fax Number	:	732-705-6055

Provider Business Practice Location Address
First Line	:	1 BETHANY RD BUILDING 1 STE 7
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1659
Country	:	US
Telephone Number	:	732-705-6266
Fax Number	:	732-705-6055

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JAMES BOOZAN
Credential	:
Telephone Number	:	732-858-4258

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	03/19/2026

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