Provider Demographics
NPI:1972788685
Name:GREATER TRENTON CMHC
Entity type:Organization
Organization Name:GREATER TRENTON CMHC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEICHENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BODIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:609-396-0800
Mailing Address - Street 1:1320 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-4526
Mailing Address - Country:US
Mailing Address - Phone:609-396-0800
Mailing Address - Fax:609-396-0881
Practice Address - Street 1:1320 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4526
Practice Address - Country:US
Practice Address - Phone:609-396-0800
Practice Address - Fax:609-396-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05345200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health