Provider Demographics
NPI:1689089344
Name:NEW AGE BEHAVIORAL PC
Entity Type:Organization
Organization Name:NEW AGE BEHAVIORAL PC
Other - Org Name:NEW AGE BEHAVIORAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALCERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-797-2810
Mailing Address - Street 1:106 CENTRE BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4131
Mailing Address - Country:US
Mailing Address - Phone:856-797-2810
Mailing Address - Fax:856-797-2811
Practice Address - Street 1:106 CENTRE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4131
Practice Address - Country:US
Practice Address - Phone:856-797-2810
Practice Address - Fax:856-797-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00433300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty