Provider Demographics
NPI:1992057160
Name:DEVELOPMENTAL DISABILITIES HEALTH PARTNERS CORP
Entity type:Organization
Organization Name:DEVELOPMENTAL DISABILITIES HEALTH PARTNERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-697-7490
Mailing Address - Street 1:1285 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3045
Mailing Address - Country:US
Mailing Address - Phone:973-338-4200
Mailing Address - Fax:973-338-4440
Practice Address - Street 1:1285 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3045
Practice Address - Country:US
Practice Address - Phone:973-338-4200
Practice Address - Fax:973-338-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0231410Medicaid