Provider Demographics
NPI:1780930164
Name:PROFESSIONAL ASSISTANCE PROGRAM OF NEW JERSEY
Entity type:Organization
Organization Name:PROFESSIONAL ASSISTANCE PROGRAM OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TIA
Authorized Official - Middle Name:VERZEL
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LAC, NCC
Authorized Official - Phone:609-919-1660
Mailing Address - Street 1:742 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6327
Mailing Address - Country:US
Mailing Address - Phone:609-919-1660
Mailing Address - Fax:609-919-1611
Practice Address - Street 1:742 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6327
Practice Address - Country:US
Practice Address - Phone:609-919-1660
Practice Address - Fax:609-919-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00099400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health