Provider Demographics
NPI:1790721108
Name:MENTAL HEALTH ASSOCIATION OF ESSEX AND MORRIS, INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF ESSEX AND MORRIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-509-9777
Mailing Address - Street 1:33 S FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3358
Mailing Address - Country:US
Mailing Address - Phone:973-509-9777
Mailing Address - Fax:973-509-9218
Practice Address - Street 1:33 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-509-9777
Practice Address - Fax:973-509-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ302090405101YM0800X, 251B00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0017744Medicaid
NJ7370202Medicaid
NJ0021903Medicaid
NJ0021903Medicaid