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NPI Code Detail

MEDICARE: WEST BERGEN MENTALHEALTHCARE, INC

MEDICARE: WEST BERGEN MENTALHEALTHCARE, INC
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
1101YM0800XMental Health Counselor301110105NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912955196
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST BERGEN MENTALHEALTHCARE, INC
Provider Business Mailing Address
First Line : 120 CHESTNUT ST
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-2504
Country : US
Telephone Number : 201-444-3550
Fax Number : 201-652-1613
Provider Business Practice Location Address
First Line : 120 CHESTNUT ST
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-2504
Country : US
Telephone Number : 201-444-3550
Fax Number : 201-652-1613
Authorized Official
Title or Position : CEO
Name : MR. MICHAEL TOZZOLI
Credential : LCSW
Telephone Number : 201-444-3550
Provider Enumeration Date : 05/04/2006
Last Update Date : 08/22/2020

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