Provider Demographics
NPI:1962567925
Name:SUSSEX COUNTY PSYCHIATRIC, INC
Entity type:Organization
Organization Name:SUSSEX COUNTY PSYCHIATRIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-426-1640
Mailing Address - Street 1:185 STATE ROUTE 183
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-1212
Mailing Address - Country:US
Mailing Address - Phone:973-426-1640
Mailing Address - Fax:973-426-1641
Practice Address - Street 1:185 STATE ROUTE 183
Practice Address - Street 2:
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874-1212
Practice Address - Country:US
Practice Address - Phone:973-426-1640
Practice Address - Fax:973-426-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
NJ35SI00378800103TB0200X
NJ35SI00320600103TB0200X
NJ44SC05174300104100000X
NJMA67288002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8699003Medicaid
NJ053193Medicare UPIN