Provider Demographics
NPI:1427320357
Name:MENTAL HEALTH ASSOCIATION OF ESSEX AND MORRIS
Entity type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF ESSEX AND MORRIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:OLUFUNMILAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:ILORI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:973-674-8067
Mailing Address - Street 1:424
Mailing Address - Street 2:MAIN STREET
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018
Mailing Address - Country:US
Mailing Address - Phone:973-674-8067
Mailing Address - Fax:973-677-7719
Practice Address - Street 1:33 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-674-8067
Practice Address - Fax:973-677-7719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH ASSOCIATION OF ESSEX AND MORRIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00355200261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00355200OtherADVANCED PRACTICE WITH PRESCRIPTIVE AUTHORITY
NJP00440300OtherCDS REGISTRATION NUMBER
NJP00440300OtherCDS REGISTRATION NUMBER