Provider Demographics
NPI:1407913924
Name:PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC.
Entity Type:Organization
Organization Name:PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-458-1700
Mailing Address - Street 1:PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY
Mailing Address - Street 2:PO BOX 2036
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-458-1700
Mailing Address - Fax:732-785-3296
Practice Address - Street 1:PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY
Practice Address - Street 2:1500 ROUTE 88 WEST
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-458-1700
Practice Address - Fax:732-785-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2030201004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8541108Medicaid
NJ8541108Medicaid