Garden State Psychiatric Services, LLC
Organization Active NPI Clinic/Center · Woodbury, NJ
NPI 1073135117 · NPPES record last updated Jul 21, 2025
Key facts
- NPI
- 1073135117
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Lisa Fulwiler
- Title
- Administration Assistant
- Phone
- (856) 628-4504
Corporate family (same tax ID) 1
Practitioners 5
-
Lauren Antonison, FNP-BC
-
Emily Bacon, APN-C
-
Nadine Elizabeth Talley, LCSW
-
Diane Wright, ANP-BC
National Provider Directory
- Tax ID family
- Garden State Psychiatric Services LLC
Locations
190 N Evergreen Ave
Ste 202
Woodbury, NJ 08096
Phone (856) 628-4504
45 Euclid St
#200
Woodbury, NJ 08096
Phone (566) 284-5048
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0722782 | Medicaid | NJ |
Other providers in Woodbury, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.