NPIMap

Organization Active NPI

Pascack Mental Health Center

  • Mental Health Counselor
  • Park Ridge, NJ
National Provider Identifier
1154526440
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PASCACK MENTAL HEALTH CENTER
Practice address
114 Kinderkamack Road
Park Ridge, NJ 07656-2126
Phone
(201) 391-1355
Fax
(201) 391-9516
NPI assigned
Jun 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

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

Authorized official

Name
Mr. Jorge BecerraNPI 1205225877
Title
Executive Director
Phone
(201) 391-1355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X Primary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X

Addresses

Primary practice location

114 Kinderkamack Road
Park Ridge, NJ 07656-2126

Mailing address

PO Box 126
114 Kinderkamack Road
Park Ridge, NJ 07656-2126
Phone (201) 391-1355

Other identifiers 1

IdentifierTypeStateIssuer
0020303MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1154526440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126",
            "address_2": "114 KINDERKAMACK ROAD",
            "city": "PARK RIDGE",
            "state": "NJ",
            "postal_code": "076562126",
            "telephone_number": "201-391-1355",
            "fax_number": "201-391-9516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 KINDERKAMACK ROAD",
            "city": "PARK RIDGE",
            "state": "NJ",
            "postal_code": "076562126",
            "telephone_number": "201-391-1355",
            "fax_number": "201-391-9516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASCACK MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "BECERRA",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "201-391-1355",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0020303",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; 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.