# BERGEN PSYCHIATRIC CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295255149
- **Authorized official:** MINI THOMAS MBBS (CCRP)
- **Authorized official phone:** (201) 956-9483

## Contact information

- **Practice address:** 65 N MAPLE AVE STE 104, RIDGEWOOD, NJ 07450-3233
- **Practice address phone:** (201) 956-9483
- **Practice address fax:** (201) 288-5262
- **Mailing address:** 65 N MAPLE AVE STE 104, RIDGEWOOD, NJ 07450-3233
- **Mailing address phone:** (201) 956-9483
- **Mailing address fax:** (201) 288-5262

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/21/2017
- **Last updated:** 03/18/2019