Provider Demographics
NPI:1316189830
Name:CREATIVE INTERVENTION FOR MENTAL HEALTH AND CHEMICAL DEPENDENCY,PC
Entity Type:Organization
Organization Name:CREATIVE INTERVENTION FOR MENTAL HEALTH AND CHEMICAL DEPENDENCY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOCHFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-662-3096
Mailing Address - Street 1:20 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2503
Mailing Address - Country:US
Mailing Address - Phone:609-406-0100
Mailing Address - Fax:609-406-0307
Practice Address - Street 1:1149 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2314
Practice Address - Country:US
Practice Address - Phone:973-365-2300
Practice Address - Fax:973-365-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherMEDICARE PENDING