MEDICARE: MOUNT CARMEL GUILD

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	44SL05323500	NJ

General Provider Information

NPI Number	:	1871670570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT CARMEL GUILD

Provider Business Mailing Address
First Line	:	36 WESTSIDE AVE
Second Line	:
City	:	AVENEL
State	:	NJ
Zip	:	07001-1423
Country	:	US
Telephone Number	:	732-726-9624
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 BERGENLINE AVE
Second Line	:	SECOND FLOOR
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3582
Country	:	US
Telephone Number	:	201-558-3700
Fax Number	:	201-392-5048

Authorized Official
Title or Position	:	TEAM LEADER
Name	:	PROF. CORINA E HARTEN
Credential	:	LMS
Telephone Number	:	201-558-3726

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/21/2022

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1982780516 — MRS. PATRICIA DALY LCSW
Practice Location Address:

2201 BERGENLINE AVE
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07087-3582

Practice Phone: 201-558-3724
Practice Fax:

1497833321 — DR. ELLEN M CLARK PH.D
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1366581803 — MS. CYNTHIA A REA RN, C, BA
Practice Location Address:

2201 BERGENLINE AVE , 2ND FLOOR
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Practice Phone: 201-558-3700
Practice Fax:

1386765113 — MISS AHYLZABETH GIANNANTONIO MSW, LCSW
Practice Location Address:

2201 BERGENLINE AVE
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Practice Fax:

1487985057 — MOUNT CARMEL GUILD BEHAVIORAL HEALTH SYSTEM
Practice Location Address:

2201 BERGENLINE AVE
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1316249022 — LUZ E FONTANEZ MA
Practice Location Address:

2201 BERGENLINE AVE
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Directions to “MOUNT CARMEL GUILD ” Practice Location

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