Provider Demographics
NPI:1295359115
Name:HODGES-METAMORPHOSIS
Entity Type:Organization
Organization Name:HODGES-METAMORPHOSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARETTTA
Authorized Official - Middle Name:HODGES
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:EDM, MSW
Authorized Official - Phone:973-444-5341
Mailing Address - Street 1:100 SELVAGE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4819
Mailing Address - Country:US
Mailing Address - Phone:973-444-5341
Mailing Address - Fax:201-255-7352
Practice Address - Street 1:241 HUDSON ST STE 33
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6708
Practice Address - Country:US
Practice Address - Phone:201-255-7348
Practice Address - Fax:201-255-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No177F00000XOther Service ProvidersLodging
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ721247Medicaid