Provider Demographics
NPI:1619009701
Name:MENTAL HEALTH CLINIC OF PASSAIC INC
Entity Type:Organization
Organization Name:MENTAL HEALTH CLINIC OF PASSAIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYBIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:973-473-2775
Mailing Address - Street 1:1451 VAN HOUTEN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2432
Mailing Address - Country:US
Mailing Address - Phone:973-473-2775
Mailing Address - Fax:973-473-3625
Practice Address - Street 1:1451 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2432
Practice Address - Country:US
Practice Address - Phone:973-473-2775
Practice Address - Fax:973-473-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ304050204251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0089559Medicaid
NJ0021181Medicaid
NJ0014508Medicaid
NJ0014508Medicaid