| Park Place | |
|
1011 Bond St Asbury Park NJ 07712-5939 | |
| (732) 859-1794 | |
| Not Available |
| Full Name | Park Place |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1011 Bond St, Asbury Park, New Jersey |
| Authorized Official Name and Position | Peter E Dougherty (CLINICAL SUPERVISOR) |
| Authorized Official Contact | 7328692773 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Place 1011 Bond St Asbury Park NJ 07712-5939 Ph: (732) 859-1794 | Park Place 1011 Bond St Asbury Park NJ 07712-5939 Ph: (732) 859-1794 |
| NPI Number | 1952654972 |
|---|---|
| Provider Enumeration Date | 10/16/2012 |
| Last Update Date | 10/16/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952654972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 44SC05427900 (New Jersey) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | 37LC00188000 (New Jersey) | Secondary |
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