NPIMap

Organization Active NPI

Garden State Psychiatric Services, LLC

  • Clinic/Center
  • Woodbury, NJ
National Provider Identifier
1073135117
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GARDEN STATE PSYCHIATRIC SERVICES, LLC
Practice address
190 N Evergreen Ave Ste 202
Woodbury, NJ 08096-1862
Phone
(856) 628-4504
Fax
(856) 494-1549
NPI assigned
May 12, 2020
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Fulwiler
Title
Administration Assistant
Phone
(856) 628-4504

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

190 N Evergreen Ave Ste 202
Woodbury, NJ 08096-1862

Mailing address

190 N Evergreen Ave Ste 202
Woodbury, NJ 08096-1862
Phone (856) 628-4504

National Provider Directory

National Provider Directory
Tax ID family
Garden State Psychiatric Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

45 Euclid St
#200
Woodbury, NJ 08096
Phone (566) 284-5048

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1073135117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 N EVERGREEN AVE STE 202",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961862",
            "telephone_number": "856-628-4504",
            "fax_number": "856-494-1549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 N EVERGREEN AVE STE 202",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961862",
            "telephone_number": "856-628-4504",
            "fax_number": "856-494-1549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDEN STATE PSYCHIATRIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "FULWILER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ADMINISTRATION ASSISTANT",
        "authorized_official_telephone_number": "856-628-4504"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.