Provider Demographics
NPI:1598808594
Name:SAULS, ANTIONETTE (CADC)
Entity Type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:
Last Name:SAULS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 DORCHESTER DR # C
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6325
Mailing Address - Country:US
Mailing Address - Phone:732-364-3469
Mailing Address - Fax:
Practice Address - Street 1:PREFERRED BEHAVIORAL HEALTH OF NJ CPSAI
Practice Address - Street 2:700 AIRPORT ROAD
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-367-4700
Practice Address - Fax:732-364-2253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00039700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)