Organization
GARDEN STATE PSYCHIATRIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA FULWILER (ADMINISTRATION ASSISTANT)
(856) 628-4504
Entity
Organization
Contact information
Practice address
190 N EVERGREEN AVE STE 202, WOODBURY, NJ 08096-1862
(856) 628-4504
(856) 494-1549
Mailing address
190 N EVERGREEN AVE STE 202, WOODBURY, NJ 08096-1862
(856) 628-4504
(856) 494-1549
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0722782
—
NJ
Enumeration date
05/12/2020
Last updated
07/21/2025
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