Provider Demographics
NPI:1902250731
Name:COMMUNITOPIA
Entity Type:Organization
Organization Name:COMMUNITOPIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KHADIJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-979-6144
Mailing Address - Street 1:2101 LINCOLN HWY
Mailing Address - Street 2:404
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3329
Practice Address - Country:US
Practice Address - Phone:973-979-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00856100101Y00000X, 101YA0400X, 101YM0800X, 103K00000X, 1041C0700X
NJ44SL06046000101Y00000X, 101YA0400X, 103K00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty