Provider Demographics
NPI:1386183101
Name:UNIQUE BEHAVIORAL & MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:UNIQUE BEHAVIORAL & MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHILOMINA/AZUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWECHI/OFODIKE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:973-620-9196
Mailing Address - Street 1:16 WEST BLACKWELL STREET UNIT 201D
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801
Mailing Address - Country:US
Mailing Address - Phone:973-620-9196
Mailing Address - Fax:
Practice Address - Street 1:16 W BLACKWELL ST STE 201D
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3996
Practice Address - Country:US
Practice Address - Phone:973-620-9196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00508400261QM0801X
NJ26NJ00477000261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)