Provider Demographics
NPI:1629122262
Name:BEACON BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BEACON BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:BEACON BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MCCLARY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSW
Authorized Official - Phone:908-391-9241
Mailing Address - Street 1:154 COOPER RD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-9128
Mailing Address - Country:US
Mailing Address - Phone:856-767-4690
Mailing Address - Fax:856-767-4695
Practice Address - Street 1:154 COOPER RD
Practice Address - Street 2:SUITE 801
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-9128
Practice Address - Country:US
Practice Address - Phone:856-767-4690
Practice Address - Fax:856-767-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062294Medicaid