Provider Demographics
NPI:1396036042
Name:THE WILLOW TREE CENTER
Entity Type:Organization
Organization Name:THE WILLOW TREE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-682-8733
Mailing Address - Street 1:415 SPEEDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950
Mailing Address - Country:US
Mailing Address - Phone:973-682-8733
Mailing Address - Fax:973-682-8734
Practice Address - Street 1:415 SPEEDWELL AVE
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950
Practice Address - Country:US
Practice Address - Phone:973-682-8733
Practice Address - Fax:973-682-8734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WILLOW TREE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000195-07101YA0400X
NJ37PC0822101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty