Provider Demographics
NPI:1073848099
Name:CBS SPECIALIZED PROGRAMS
Entity Type:Organization
Organization Name:CBS SPECIALIZED PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:908-854-0164
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-0475
Mailing Address - Country:US
Mailing Address - Phone:908-854-0164
Mailing Address - Fax:908-765-0291
Practice Address - Street 1:117 GRAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2128
Practice Address - Country:US
Practice Address - Phone:908-854-0164
Practice Address - Fax:908-765-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0162159251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162159Medicaid