| Prospect House | |
|
33 S Fullerton Ave Montclair NJ 07042 | |
| (973) 674-8067 | |
| (973) 677-7719 |
| Full Name | Prospect House |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 33 S Fullerton Ave, Montclair, New Jersey |
| Authorized Official Name and Position | Olufunmilayo O Ilori (ADVANCED PRACTICE NURSE) |
| Authorized Official Contact | 9736748067 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospect House 424 Main Street East Orange NJ 07018 Ph: (973) 674-8067 | Prospect House 33 S Fullerton Ave Montclair NJ 07042 Ph: (973) 674-8067 |
| NPI Number | 1427320357 |
|---|---|
| Provider Enumeration Date | 02/08/2012 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427320357 | NPI | - | NPPES |
| 26NJ00355200 | Other | NJ | ADVANCED PRACTICE WITH PRESCRIPTIVE AUTHORITY |
| P00440300 | Other | NJ | CDS REGISTRATION NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 26NJ00355200 (New Jersey) | Primary |
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