Basic Information
| Provider Information | |||||||||
| NPI: | 1558699082 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEAMHOPE HEALTHCARE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 MORRISTOWN RD | ||||||||
| Address2: | ROUTE 202 | ||||||||
| City: | BERNARDSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079242328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087667888 | ||||||||
| FaxNumber: | 9087661307 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 MORRISTOWN RD | ||||||||
| Address2: | ROUTE 202 | ||||||||
| City: | BERNARDSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079242328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087667888 | ||||||||
| FaxNumber: | 9087661307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2009 | ||||||||
| LastUpdateDate: | 11/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | FERNICOLA | ||||||||
| AuthorizedOfficialFirstName: | HOPE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9087667888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.A. CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 104100000X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 225100000X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.