Provider Demographics
NPI:1932956703
Name:BEHAVIORAL HEALTH ASSOCIATES OF NEW JERSEY LLC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH ASSOCIATES OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONCALVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-542-0703
Mailing Address - Street 1:9 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3001
Mailing Address - Country:US
Mailing Address - Phone:973-542-0703
Mailing Address - Fax:
Practice Address - Street 1:9 BRIAR LN
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3001
Practice Address - Country:US
Practice Address - Phone:973-542-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health