Provider Demographics
NPI:1023457645
Name:BEHAVIORAL HEALTH SERVICES OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH SERVICES OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STABACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-463-9665
Mailing Address - Street 1:30 KNIGHTSBRIDGE RD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3948
Mailing Address - Country:US
Mailing Address - Phone:908-463-9665
Mailing Address - Fax:
Practice Address - Street 1:1 CRABAPPLE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1406
Practice Address - Country:US
Practice Address - Phone:908-463-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty