Provider Demographics
NPI:1164542718
Name:REGROUP BEHAVIORAL HEALTH SERVICES,PC
Entity Type:Organization
Organization Name:REGROUP BEHAVIORAL HEALTH SERVICES,PC
Other - Org Name:REGROUP PRINCETTA'S BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRINCETTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-755-3392
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-0512
Mailing Address - Country:US
Mailing Address - Phone:908-755-3392
Mailing Address - Fax:908-755-4768
Practice Address - Street 1:1314 PARK AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3253
Practice Address - Country:US
Practice Address - Phone:908-755-3392
Practice Address - Fax:908-755-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099182U5TMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
NJ099181Medicare ID - Type UnspecifiedMEDICARE GROUP
NJ068524U5TMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL