Provider Demographics
NPI:1548616840
Name:ABSOLUTELY DRIVEN MENTAL HEALTH PROVIDER LLC
Entity Type:Organization
Organization Name:ABSOLUTELY DRIVEN MENTAL HEALTH PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-574-5640
Mailing Address - Street 1:100 VALLEY RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEY RD
Practice Address - Street 2:SUITE1
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2200
Practice Address - Country:US
Practice Address - Phone:201-574-5640
Practice Address - Fax:973-783-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00453700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty