Provider Demographics
NPI:1790282226
Name:ASSOCIATES IN MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, INC.
Entity Type:Organization
Organization Name:ASSOCIATES IN MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CSW, CBT, CCT, C
Authorized Official - Phone:973-676-8899
Mailing Address - Street 1:370 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050
Mailing Address - Country:US
Mailing Address - Phone:973-677-7979
Mailing Address - Fax:973-677-9877
Practice Address - Street 1:370 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050
Practice Address - Country:US
Practice Address - Phone:973-677-7979
Practice Address - Fax:973-677-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00354400251E00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0433365Medicaid