Provider Demographics
NPI:1396205563
Name:ESSEX PSYCHIATRIC CENTER FOR CHILDREN & ADULTS LLC
Entity Type:Organization
Organization Name:ESSEX PSYCHIATRIC CENTER FOR CHILDREN & ADULTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMETRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-805-6046
Mailing Address - Street 1:38 TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4600
Mailing Address - Country:US
Mailing Address - Phone:201-805-6046
Mailing Address - Fax:
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:201-805-6046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty