Provider Demographics
NPI:1356588719
Name:BANYAN TREE MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:BANYAN TREE MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VOCATURO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, ABPP
Authorized Official - Phone:732-735-3925
Mailing Address - Street 1:PO BOX 6776
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-6776
Mailing Address - Country:US
Mailing Address - Phone:732-247-9505
Mailing Address - Fax:973-324-3641
Practice Address - Street 1:19A DELLWOOD LANE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-247-9505
Practice Address - Fax:973-324-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100391200261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ049323Medicare PIN