Provider Demographics
NPI:1003824624
Name:BEHAVIORAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, APN,C
Authorized Official - Phone:973-940-0116
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-0065
Mailing Address - Country:US
Mailing Address - Phone:973-940-0116
Mailing Address - Fax:973-940-0104
Practice Address - Street 1:18 CHURCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1756
Practice Address - Country:US
Practice Address - Phone:973-940-0116
Practice Address - Fax:973-940-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC04592400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7227701Medicaid
NJ102682Medicare PIN