NPIMap

Organization Active NPI

South Jersey Behavioral Health Resources Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Camden, NJ
National Provider Identifier
1194946053
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
403010304 Issued in NJ
Legal business name
SOUTH JERSEY BEHAVIORAL HEALTH RESOURCES INCORPORATED
Practice address
400 Market St
1St Floor
Camden, NJ 08102-1526
Phone
(856) 541-1700
Fax
(856) 541-1554
NPI assigned
May 1, 2007
Reactivated
Jul 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Theresa C Wilson, MSW LCSW
Title
President/Ceo
Phone
(856) 361-1133

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X 403010305 NJ
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 403010304 NJ Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 403010904 NJ

Addresses

Primary practice location

400 Market St
1St Floor
Camden, NJ 08102-1526

Mailing address

2500 McClellan Ave Ste 300
Pennsauken, NJ 08109-0001
Phone (856) 361-1133

Other practice location 1

53 Haddonfield Rd Ste 316
Cherry Hill, NJ 08002-4802
Phone (856) 361-2710

Other identifiers 8

IdentifierTypeStateIssuer
406010904OtherNJDMHAS LICENSE
0041106MedicaidNJ
0515752MedicaidNJ
403010305OtherNJDMHS LICENSE
7477007MedicaidNJ
7677308OtherNJWORKFORCE NJ
403010304OtherNJDMHAS LICENSE
403010904OtherNJDMHAS LICENSE

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.

Locations

400 Market St
Fl 1
Camden, NJ 08102
Phone (856) 541-1700

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1194946053",
    "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": "856-361-1133",
            "fax_number": "856-488-1450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MARKET ST",
            "address_2": "1ST FLOOR",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081021526",
            "telephone_number": "856-541-1700",
            "fax_number": "856-541-1554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "53 Haddonfield Rd Ste 316",
            "address_purpose": "LOCATION",
            "city": "Cherry Hill",
            "state": "NJ",
            "postal_code": "080024802",
            "country_code": "US",
            "telephone_number": "856-361-2710",
            "fax_number": "856-488-1450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH JERSEY BEHAVIORAL HEALTH RESOURCES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2022-07-21",
        "deactivation_date": "2008-05-22",
        "reactivation_date": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "856-361-1133",
        "authorized_official_credential": "MSW LCSW"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "NJ",
            "license": "403010305",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NJ",
            "license": "403010304",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NJ",
            "license": "403010904",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMHAS LICENSE",
            "identifier": "406010904",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0041106",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0515752",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMHS LICENSE",
            "identifier": "403010305",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7477007",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKFORCE NJ",
            "identifier": "7677308",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMHAS LICENSE",
            "identifier": "403010304",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMHAS LICENSE",
            "identifier": "403010904",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.