MEDICARE: CLEAR WATERS BEHAVIORAL HEALTH PC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1477072106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR WATERS BEHAVIORAL HEALTH PC

Provider Business Mailing Address
First Line	:	3 CORBETT WAY
Second Line	:
City	:	EATONTOWN
State	:	NJ
Zip	:	07724-2283
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 HOPE RD STE 5B
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-1273
Country	:	US
Telephone Number	:	732-210-0509
Fax Number	:

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	PRITI KUMAR
Credential	:
Telephone Number	:	732-210-0509

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	09/13/2017

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