PA Mental Health

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PA MENTAL HEALTH

Doing business as

PA Mental Health

Practice address

204 Erie St Ste 2FL
Elizabeth, NJ 07206-1569

Phone

(908) 759-2370

Fax

(908) 469-5817

NPI assigned

Dec 28, 2018

Last updated

Dec 28, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Miguel A Matos, LPC

Title

Licensed Mental Health Coun Ceo

Phone

(908) 759-2376

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PA Mental Health Doing business as

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

{
    "created_epoch": "1545955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545955200000",
    "number": "1821560012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 ERIE ST STE 2FL",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072061569",
            "telephone_number": "908-759-2370",
            "fax_number": "908-469-5817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 ERIE ST STE 2FL",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072061569",
            "telephone_number": "908-759-2370",
            "fax_number": "908-469-5817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PA MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-28",
        "last_updated": "2018-12-28",
        "status": "A",
        "authorized_official_last_name": "MATOS",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "LICENSED MENTAL HEALTH COUN CEO",
        "authorized_official_telephone_number": "908-759-2376",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1033399555",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PA Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; 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.