Basic Information
Provider Information
NPI: 1467985838
EntityType: 2
ReplacementNPI:  
OrganizationName: ATLANTICARE BEHAVIORAL HEALTH, INC.
LastName:  
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Credential:  
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Mailing Information
Address1: 6550 DELILAH RD STE 301
Address2:  
City: EGG HARBOR TOWNSHIP
State: NJ
PostalCode: 082345102
CountryCode: US
TelephoneNumber: 6096457600
FaxNumber: 6096457343
Practice Location
Address1: 2511 FIRE RD STE B10
Address2:  
City: EGG HARBOR TOWNSHIP
State: NJ
PostalCode: 082345655
CountryCode: US
TelephoneNumber: 6092728580
FaxNumber: 6096457343
Other Information
ProviderEnumerationDate: 04/04/2017
LastUpdateDate: 12/18/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DREW
AuthorizedOfficialFirstName: JULIA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SYSTEM EXEC. DIR. BEHAVE. HEALTH
AuthorizedOfficialTelephone: 6096457600
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: LCSW, MPA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X400050148NJY AgenciesCommunity/Behavioral Health 

ID Information
IDTypeStateIssuerDescription
055508805NJ MEDICAID


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