Provider Demographics
NPI:1497819866
Name:ST. CLARES HOSPITAL
Entity Type:Organization
Organization Name:ST. CLARES HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:DEVALVE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:973-316-1906
Mailing Address - Street 1:19 THRUMONT RD
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7719
Mailing Address - Country:US
Mailing Address - Phone:973-618-1468
Mailing Address - Fax:
Practice Address - Street 1:130 POWERVILLE RD
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-8705
Practice Address - Country:US
Practice Address - Phone:973-316-1906
Practice Address - Fax:973-316-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00012200276400000X
NJ37PC00001000276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit