Provider Demographics
NPI:1013733542
Name:TRIVEPATH MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:TRIVEPATH MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:267-629-4064
Mailing Address - Street 1:103 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-1842
Mailing Address - Country:US
Mailing Address - Phone:267-629-4064
Mailing Address - Fax:
Practice Address - Street 1:103 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-1842
Practice Address - Country:US
Practice Address - Phone:267-629-4064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health