Provider Demographics
NPI:1548483928
Name:CENTERS FOR BEHAVIORAL SUCCESS
Entity type:Organization
Organization Name:CENTERS FOR BEHAVIORAL SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:973-409-0771
Mailing Address - Street 1:11 KIEL AVE
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2549
Mailing Address - Country:US
Mailing Address - Phone:973-409-0771
Mailing Address - Fax:973-283-0090
Practice Address - Street 1:11 KIEL AVE
Practice Address - Street 2:SUITE D-2
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2549
Practice Address - Country:US
Practice Address - Phone:973-409-0771
Practice Address - Fax:973-283-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0041327Medicaid
NJ0041181Medicaid
NJ0041335Medicaid
NJ0041351Medicaid
NJ0041301Medicaid