| Outpatient Behavioral Health Department | |
|
1 Bay Ave Montclair NJ 07042-4837 | |
| (973) 429-6338 | |
| (973) 680-7715 |
| Full Name | Outpatient Behavioral Health Department |
|---|---|
| Speciality | Clinic/Center |
| Location | 1 Bay Ave, Montclair, New Jersey |
| Authorized Official Name and Position | Joe Johnson (VICE PRESIDENT) |
| Authorized Official Contact | 8664659222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Outpatient Behavioral Health Department 1 Bay Ave Montclair NJ 07042-4837 Ph: (973) 429-6000 | Outpatient Behavioral Health Department 1 Bay Ave Montclair NJ 07042-4837 Ph: (973) 429-6338 |
| NPI Number | 1386893659 |
|---|---|
| Provider Enumeration Date | 09/11/2008 |
| Last Update Date | 06/11/2013 |
| Medicare PECOS PAC ID | 7810092814 |
|---|---|
| Medicare Enrollment ID | O20090519000038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386893659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Stephanie J Kahn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750468369 PECOS PAC ID: 5294704938 Enrollment ID: I20040929000369 |
| Provider Name | Nancy Osgoodby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003904533 PECOS PAC ID: 6103866595 Enrollment ID: I20050505000022 |
| Provider Name | Nancy L Herron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619067006 PECOS PAC ID: 0446329627 Enrollment ID: I20080514000009 |
| Provider Name | Ketaki Vaidhyanathan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992904445 PECOS PAC ID: 0446309645 Enrollment ID: I20090519000058 |
| Provider Name | Marie K Salwen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144307752 PECOS PAC ID: 3971598053 Enrollment ID: I20091208000522 |
| Provider Name | Edward J Petrarca |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003986787 PECOS PAC ID: 9335289396 Enrollment ID: I20091223000076 |
| Provider Name | Christina L Van Jura |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679877179 PECOS PAC ID: 3779756861 Enrollment ID: I20111107000148 |
| Provider Name | Michelle L Harney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013266725 PECOS PAC ID: 6800046194 Enrollment ID: I20121023000110 |
| Provider Name | Kaitlyn M Tlusty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073923124 PECOS PAC ID: 1557681772 Enrollment ID: I20150528002439 |
| Provider Name | Elizabeth Mac Ewen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053724823 PECOS PAC ID: 0648577056 Enrollment ID: I20160330002050 |
| Provider Name | Sara Parisi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629492657 PECOS PAC ID: 4981993144 Enrollment ID: I20160512000179 |
| Provider Name | Katie Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770097982 PECOS PAC ID: 8820338569 Enrollment ID: I20190318000042 |
| Provider Name | Stephanie Damiano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114446309 PECOS PAC ID: 6800126780 Enrollment ID: I20190918002801 |
| Provider Name | Tara Fries |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902441256 PECOS PAC ID: 5496189755 Enrollment ID: I20191220000216 |
| Provider Name | Carly Parisi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609410190 PECOS PAC ID: 0042644775 Enrollment ID: I20200106000257 |
| Provider Name | Kelsey Oakes Bisson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942740477 PECOS PAC ID: 7810327269 Enrollment ID: I20200427000062 |
| Provider Name | Jennifer Stuart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144709239 PECOS PAC ID: 6204256183 Enrollment ID: I20201014002242 |
| Provider Name | Stephen Schram |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093270787 PECOS PAC ID: 1456749423 Enrollment ID: I20211025000030 |
| Provider Name | Diane P Browne |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326125089 PECOS PAC ID: 1658670658 Enrollment ID: I20240307001802 |
| Provider Name | Stephanie Mora |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871230243 PECOS PAC ID: 8426497751 Enrollment ID: I20240418002571 |
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