Provider Demographics
NPI:1598999666
Name:PREFERRED BEHAVIORAL HEALTH OF NJ
Entity Type:Organization
Organization Name:PREFERRED BEHAVIORAL HEALTH OF NJ
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:PO BOX 2036
Mailing Address - Street 2:IOTSS PROGRAM
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-8036
Mailing Address - Country:US
Mailing Address - Phone:732-367-8859
Mailing Address - Fax:732-364-8242
Practice Address - Street 1:725 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5968
Practice Address - Country:US
Practice Address - Phone:732-367-8859
Practice Address - Fax:732-367-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20302-17-04261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ526788OtherGROUP MEDICARE NUMBER
NJ5255902Medicaid