Provider Demographics
NPI:1417165358
Name:MENTAL HEALTH ASSOCIATION
Entity type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ACHILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-542-6422
Mailing Address - Street 1:106 APPLE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2670
Mailing Address - Country:US
Mailing Address - Phone:732-542-6422
Mailing Address - Fax:
Practice Address - Street 1:106 APPLE ST STE 110
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-2670
Practice Address - Country:US
Practice Address - Phone:732-542-6422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024635Medicaid