Provider Demographics
NPI:1336643295
Name:NEW BEHAVIORAL NETWORK
Entity Type:Organization
Organization Name:NEW BEHAVIORAL NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:BOETTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-669-0217
Mailing Address - Street 1:2 PIN OAK LN STE 250
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1630
Mailing Address - Country:US
Mailing Address - Phone:856-666-0217
Mailing Address - Fax:
Practice Address - Street 1:5 CARNEGIE PLZ
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1020
Practice Address - Country:US
Practice Address - Phone:856-669-0217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)