Provider Demographics
NPI:1780238428
Name:DOC OCTAVIUS MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:DOC OCTAVIUS MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:OCTAVIUS
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:914-261-6532
Mailing Address - Street 1:542 S BROADWAY APT H19
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-2675
Mailing Address - Country:US
Mailing Address - Phone:914-261-6532
Mailing Address - Fax:
Practice Address - Street 1:542 S BROADWAY APT H19
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-2675
Practice Address - Country:US
Practice Address - Phone:914-261-6532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty