Provider Demographics
NPI:1114424405
Name:ASSOCIATES IN MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, INC
Entity Type:Organization
Organization Name:ASSOCIATES IN MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CSW, CBT, CCSP, C
Authorized Official - Phone:973-676-8899
Mailing Address - Street 1:370 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050
Mailing Address - Country:US
Mailing Address - Phone:973-677-7979
Mailing Address - Fax:973-677-7899
Practice Address - Street 1:370 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050
Practice Address - Country:US
Practice Address - Phone:973-677-7979
Practice Address - Fax:973-677-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 222Q00000X
NJ44SC00354400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0427748Medicaid