Provider Demographics
NPI:1043360266
Name:CREATIVE INTERVENTION FOR MENTAL HEALTH AND CHEMICAL DEPENDENCY, PC
Entity Type:Organization
Organization Name:CREATIVE INTERVENTION FOR MENTAL HEALTH AND CHEMICAL DEPENDENCY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOCHFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-662-3096
Mailing Address - Street 1:20 SCOTCH ROAD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2503
Mailing Address - Country:US
Mailing Address - Phone:609-406-0100
Mailing Address - Fax:609-406-0307
Practice Address - Street 1:1149 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2314
Practice Address - Country:US
Practice Address - Phone:973-365-2300
Practice Address - Fax:973-365-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty