Provider Demographics
NPI:1396129839
Name:JOHN MCLERNON MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:JOHN MCLERNON MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCLERNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-703-2036
Mailing Address - Street 1:2404 SHEPHERD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1419
Mailing Address - Country:US
Mailing Address - Phone:609-703-2036
Mailing Address - Fax:609-383-6062
Practice Address - Street 1:450 TILTON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1256
Practice Address - Country:US
Practice Address - Phone:609-703-2036
Practice Address - Fax:609-383-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05365300261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)