NPIMap

Organization Active NPI

Mental Health Clinic of Passaic Inc

  • Community/Behavioral Health Agency
  • Clifton, NJ
National Provider Identifier
1619009701
Registry record updated Apr 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
304050204 Issued in NJ
Legal business name
MENTAL HEALTH CLINIC OF PASSAIC INC
Practice address
1451 Van Houten Ave
Clifton, NJ 07013-2432
Phone
(973) 473-2775
Fax
(973) 473-3625
NPI assigned
Mar 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2018

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

Authorized official

Name
Dr. Sybil Schreiber, D.SW
Title
Executive Director
Phone
(973) 473-2775

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 304050204 NJ Primary

Addresses

Primary practice location

1451 Van Houten Ave
Clifton, NJ 07013-2432

Mailing address

1451 Van Houten Ave
Clifton, NJ 07013-2432
Phone (973) 473-2775

Other identifiers 3

IdentifierTypeStateIssuer
0089559MedicaidNJ
0021181MedicaidNJ
0014508MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120228000096 NJ Part B Supplier - Clinic/Group Practice 6901064617 Receives reassigned benefits from 3 practitioners
Practice locations: Clifton, NJ; Passaic, NJ

National Provider Directory

National Provider Directory

Locations

1451 Van Houten Ave
Clifton, NJ 07013
Phone (973) 473-2775

124 Gregory Ave
Ste 202
Passaic, NJ 07055
Phone (973) 928-7244

111 Lexington Ave
Passaic, NJ 07055
Phone (973) 471-8006

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/mhcp/r4/

Practitioners & affiliated clinicians

Practitioners 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524182400000",
    "number": "1619009701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 VAN HOUTEN AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070132432",
            "telephone_number": "973-473-2775",
            "fax_number": "973-473-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 VAN HOUTEN AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070132432",
            "telephone_number": "973-473-2775",
            "fax_number": "973-473-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL HEALTH CLINIC OF PASSAIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2018-04-20",
        "status": "A",
        "authorized_official_last_name": "SCHREIBER",
        "authorized_official_first_name": "SYBIL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "973-473-2775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.SW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NJ",
            "license": "304050204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0089559",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0021181",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0014508",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.