Organization
PORTUM BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADEENA JACOBSON (OWNER)
(917) 882-2744
Entity
Organization
Contact information
Practice address
1465 ROUTE 31 S STE 1101-1102, ANNANDALE, NJ 08801-3129
(551) 306-4000
Mailing address
1465 ROUTE 31 S STE 1101-1102, ANNANDALE, NJ 08801-3129
(551) 306-4000
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/09/2024
Last updated
06/16/2026
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