Provider Demographics
NPI:1215082268
Name:THE CENTER FOR OPTIMUM LIVING, INC.
Entity type:Organization
Organization Name:THE CENTER FOR OPTIMUM LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BENANTI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-838-8375
Mailing Address - Street 1:6 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2306
Mailing Address - Country:US
Mailing Address - Phone:973-838-8375
Mailing Address - Fax:973-838-0603
Practice Address - Street 1:6 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2306
Practice Address - Country:US
Practice Address - Phone:973-838-8375
Practice Address - Fax:973-838-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00100000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty