Provider Demographics
NPI:1013093665
Name:MT CARMEL GUILD
Entity Type:Organization
Organization Name:MT CARMEL GUILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:VASWATI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLIK
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:908-497-3968
Mailing Address - Street 1:4 DITZEL FARM RD
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2946
Mailing Address - Country:US
Mailing Address - Phone:908-233-7141
Mailing Address - Fax:908-233-7818
Practice Address - Street 1:108 ALDEN ST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2131
Practice Address - Country:US
Practice Address - Phone:908-497-3968
Practice Address - Fax:908-272-9268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05300000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health