NPIMap

Organization Active NPI

Extracare Health Services

  • Addiction (Substance Use Disorder) Psychologist
  • Matawan, NJ
National Provider Identifier
1750435129
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
License
PSYD-2136 Issued in NJ
Legal business name
EXTRACARE HEALTH SERVICES
Practice address
141 State Route 34
Matawan, NJ 07747-2187
Phone
(732) 721-3835
Fax
(239) 455-9027
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
John J Kelly, CSW, CDC
Title
Executive Director
Phone
(732) 721-0060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TA0400X PSYD-2136 NJ Primary

Addresses

Primary practice location

141 State Route 34
Matawan, NJ 07747-2187

Mailing address

141 State Route 34
P O Box 506
Matawan, NJ 07747-2187
Phone (732) 721-3835

National Provider Directory

National Provider Directory

Locations

141 State Route 34
Matawan, NJ 07747
Phone (732) 721-3835

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750435129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 STATE ROUTE 34",
            "address_2": "P O BOX 506",
            "city": "MATAWAN",
            "state": "NJ",
            "postal_code": "077472187",
            "telephone_number": "732-721-3835",
            "fax_number": "239-455-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 STATE ROUTE 34",
            "city": "MATAWAN",
            "state": "NJ",
            "postal_code": "077472187",
            "telephone_number": "732-721-3835",
            "fax_number": "239-455-9027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTRACARE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "732-721-0060",
        "authorized_official_credential": "CSW, CDC"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "PSYD-2136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matawan, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.