Provider Demographics
NPI:1689362469
Name:MONMOUTH BEHAVIORAL THERAPY GROUP, CORP
Entity Type:Organization
Organization Name:MONMOUTH BEHAVIORAL THERAPY GROUP, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-687-2418
Mailing Address - Street 1:1000 SANGER AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1241
Mailing Address - Country:US
Mailing Address - Phone:732-687-2418
Mailing Address - Fax:
Practice Address - Street 1:1000 SANGER AVE
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1241
Practice Address - Country:US
Practice Address - Phone:732-687-2418
Practice Address - Fax:732-865-7187
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE FORT ADULT DAY PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty