MEDICARE: CRP BEHAVIORAL HEALTH, 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1457852154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRP BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	642 MCCLELLAN ST
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5835
Country	:	US
Telephone Number	:	732-443-4880
Fax Number	:	732-443-4884

Provider Business Practice Location Address
First Line	:	642 MCCLELLAN ST
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5835
Country	:	US
Telephone Number	:	732-443-4880
Fax Number	:	732-443-4884

Authorized Official
Title or Position	:	PMHNP
Name	:	CHRISTINE POSSEMATO
Credential	:	APN
Telephone Number	:	732-443-4880

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	04/15/2026

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