Provider Demographics
NPI:1003935610
Name:THE LENNARD CLINIC, INC
Entity Type:Organization
Organization Name:THE LENNARD CLINIC, INC
Other - Org Name:ESSES SUBSTANCE ABUSE TREATMENT CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHALYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-704-1557
Mailing Address - Street 1:461 FRELINGHUYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-1426
Mailing Address - Country:US
Mailing Address - Phone:973-596-2850
Mailing Address - Fax:973-596-8180
Practice Address - Street 1:461 FRELINGHUYSEN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-1426
Practice Address - Country:US
Practice Address - Phone:973-596-2850
Practice Address - Fax:973-596-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
NJ261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7603801Medicaid
NJ7489200Medicaid