Provider Demographics
NPI:1407387640
Name:MENTAL HEALTH ASSOCIATION OF MONMOUTH COUNTY
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF MONMOUTH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-542-6422
Mailing Address - Street 1:119 AVENUE AT THE COMMONS
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4586
Mailing Address - Country:US
Mailing Address - Phone:732-542-6422
Mailing Address - Fax:732-542-2477
Practice Address - Street 1:119 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 5
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4586
Practice Address - Country:US
Practice Address - Phone:732-542-6422
Practice Address - Fax:732-542-2477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH ASSOCIATION OF MONMOUTH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ202110148251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024635Medicaid