Eridian Behavioral Health

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

44SC05427900 Issued in NJ

Legal business name

ERIDIAN BEHAVIORAL HEALTH

Practice address

1011 Bond St
Asbury Park, NJ 07712-5939

Phone

(732) 859-1794

NPI assigned

Oct 16, 2012

Organization subpart

Yes

Parent organization

MERIDIAN HEALTHAs reported in NPPES

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

Authorized official

Name

Mr. Peter E Dougherty, LCSW, LCADC

Title

Clinical Supervisor

Phone

(732) 869-2773

Specialties & licenses 2

Addresses

Other names 1

• Park Place Other name

Part of

Jersey Shore University Medical Center Pedi Clinic

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

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350345600000",
    "number": "1952654972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 BOND ST",
            "city": "ASBURY PARK",
            "state": "NJ",
            "postal_code": "077125939",
            "telephone_number": "732-859-1794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOND ST",
            "city": "ASBURY PARK",
            "state": "NJ",
            "postal_code": "077125939",
            "telephone_number": "732-859-1794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIDIAN BEHAVIORAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERIDIAN HEALTH",
        "enumeration_date": "2012-10-16",
        "last_updated": "2012-10-16",
        "status": "A",
        "authorized_official_last_name": "DOUGHERTY",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR",
        "authorized_official_telephone_number": "732-869-2773",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW, LCADC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NJ",
            "license": "44SC05427900",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NJ",
            "license": "37LC00188000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Joyce P. Ellis, LCSW
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• Albert G Endler, MSN
• Ellen Engel
• Epiphany House, Inc.
• Cheryl Fay, L.C.S.W
• Stacey A Ferise, LAC, NCC, DRCC
• Helen Ferlazzo, RN, APN, C. ,ACRN
• First Choice Chiropractic of Asbury Park, LLC
• First Healthcare Asbury Park LLC

• Adult Mental Health Clinic/Center in Asbury Park, NJ
• Providers in Asbury Park, NJ by specialty
• Adult Mental Health Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; 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.