Provider Demographics
NPI:1922346287
Name:PROGRESSIVE COMPREHENSIVE SERVICES LLC
Entity Type:Organization
Organization Name:PROGRESSIVE COMPREHENSIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEETA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-998-6242
Mailing Address - Street 1:100 E HANOVER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2047
Mailing Address - Country:US
Mailing Address - Phone:973-998-6242
Mailing Address - Fax:973-998-6240
Practice Address - Street 1:100 E HANOVER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2020
Practice Address - Country:US
Practice Address - Phone:973-998-6242
Practice Address - Fax:973-998-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
NJ44SC00847800251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1114266715Medicaid