NPIMap

Organization Active NPI

South Jersey Behavioral Health Resources Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cherry Hill, NJ
National Provider Identifier
1104348911
Registry record updated Jul 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
403010904 Issued in NJ
Legal business name
SOUTH JERSEY BEHAVIORAL HEALTH RESOURCES INCORPORATED
Practice address
53 Haddonfield Rd Ste 316
Cherry Hill, NJ 08002-4802
Phone
(856) 361-2710
Fax
(856) 346-3627
NPI assigned
Jul 13, 2017
Last updated
Jul 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2017

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

Authorized official

Name
Mrs. Theresa Wislon C Wilson, LCSW
Title
President/ Ceo
Phone
(856) 361-1120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 403010904 NJ Primary

Addresses

Primary practice location

53 Haddonfield Rd Ste 316
Cherry Hill, NJ 08002-4802

Mailing address

2500 McClellan Ave Ste 300
Pennsauken, NJ 08109-0001
Phone (856) 361-1100

Other identifiers 2

IdentifierTypeStateIssuer
0515752MedicaidNJ
403010904OtherNJNJ DMHAS

National Provider Directory

National Provider Directory
Tax ID family
South Jersey Behavioral Health Resources Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499904000000",
    "number": "1104348911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 MCCLELLAN AVE STE 300",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "081090001",
            "telephone_number": "856-361-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 HADDONFIELD RD STE 316",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080024802",
            "telephone_number": "856-361-2710",
            "fax_number": "856-346-3627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JERSEY BEHAVIORAL HEALTH RESOURCES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-13",
        "last_updated": "2017-07-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "THERESA WISLON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "856-361-1120",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NJ",
            "license": "403010904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0515752",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ DMHAS",
            "identifier": "403010904",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2017; 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.