NPIMap

Organization Active NPI

West Bergen Mental Healthcare, Inc.

  • Clinic/Center
  • Ridgewood, NJ
National Provider Identifier
1881755973
Registry record updated Jan 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
30111-01 Issued in NJ
Legal business name
WEST BERGEN MENTAL HEALTHCARE, INC.
Practice address
120 Chestnut St
Ridgewood, NJ 07450-2504
Phone
(201) 444-3550
Fax
(201) 652-1613
NPI assigned
Dec 12, 2006
Last updated
Jan 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2012

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

Authorized official

Name
Mr. Michael Tozzolli, LCSW,
Title
Chief Executive Officer
Phone
(201) 444-3550

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 30111-01 NJ
Clinic/Center 261Q00000X 30111-01 NJ Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 30111-01 NJ
Mental Health Counselor 101YM0800X 30111-01 NJ
Adult Development & Aging Psychologist 103TA0700X 30111-01 NJ
Clinical Child & Adolescent Psychologist 103TC2200X 30111-01 NJ
Clinical Social Worker 1041C0700X 3011101 NJ
Marriage & Family Therapist 106H00000X 3011101 NJ
Child & Adolescent Psychiatry Physician 2084P0804X 30111-01 NJ

Addresses

Primary practice location

120 Chestnut St
Ridgewood, NJ 07450-2504

Mailing address

120 Chestnut St
Ridgewood, NJ 07450-2504
Phone (201) 444-3550

Other identifiers 2

IdentifierTypeStateIssuer
0006700MedicaidNJ
0085006MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040322000939 NJ Part B Supplier - Clinic/Group Practice 0345131272 Receives reassigned benefits from 34 practitioners
Practice locations: Ramsey, NJ; Ridgewood, NJ

National Provider Directory

National Provider Directory
Tax ID family
West Bergen Mental Health4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

860 Wyckoff Ave
Mahwah, NJ 07430
Phone (201) 448-7041

3 Post Rd
Oakland, NJ 07436
Phone (201) 651-0121

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1881755973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 CHESTNUT ST",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502504",
            "telephone_number": "201-444-3550",
            "fax_number": "201-652-1613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CHESTNUT ST",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502504",
            "telephone_number": "201-444-3550",
            "fax_number": "201-652-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST BERGEN MENTAL HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "TOZZOLLI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "201-444-3550",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW,"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NJ",
            "license": "30111-01",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NJ",
            "license": "30111-01",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "30111-01",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "30111-01",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "NJ",
            "license": "30111-01",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NJ",
            "license": "30111-01",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "3011101",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NJ",
            "license": "3011101",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NJ",
            "license": "30111-01",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006700",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0085006",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.