Provider Demographics
NPI:1154647766
Name:CENTERS FOR BEHAVIOIRAL SUCCESS INC
Entity Type:Organization
Organization Name:CENTERS FOR BEHAVIOIRAL SUCCESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAGOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-409-0771
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:973-409-0771
Mailing Address - Fax:973-409-0748
Practice Address - Street 1:1051 TUCKERTON RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2665
Practice Address - Country:US
Practice Address - Phone:973-409-0771
Practice Address - Fax:973-409-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0041351251S00000X
NJ0041335251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0041335Medicaid
NJ0041351Medicaid