Basic Information
| Provider Information | |||||||||
| NPI: | 1164753646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL GUILD BEHAVIORAL HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071072522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735964190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 285 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073063906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013954800 | ||||||||
| FaxNumber: | 2014344386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2010 | ||||||||
| LastUpdateDate: | 06/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | WESTERVELT | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9735963984 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.