Provider Demographics
NPI:1194125856
Name:PAX LUMEN BEHAVIORAL HEALTH SOLUTIONS, LLC
Entity type:Organization
Organization Name:PAX LUMEN BEHAVIORAL HEALTH SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:FAUST
Authorized Official - Last Name:PIRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-505-3068
Mailing Address - Street 1:408 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1626
Mailing Address - Country:US
Mailing Address - Phone:609-505-3068
Mailing Address - Fax:
Practice Address - Street 1:1101 KINGS HWY N
Practice Address - Street 2:SUITE 313
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1912
Practice Address - Country:US
Practice Address - Phone:609-505-3068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-01
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ448C05548400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health