Provider Demographics
NPI:1881194520
Name:GREAT EASTERN BEHAVIORAL HEALTH PARTNERS, LLC
Entity type:Organization
Organization Name:GREAT EASTERN BEHAVIORAL HEALTH PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:UMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDASSARRA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:973-728-7788
Mailing Address - Street 1:390 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9820
Mailing Address - Country:US
Mailing Address - Phone:973-728-7788
Mailing Address - Fax:973-728-7410
Practice Address - Street 1:390 MAIN RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9820
Practice Address - Country:US
Practice Address - Phone:973-728-7788
Practice Address - Fax:973-728-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0614424Medicaid