Organization
CLINICAL SPECIALIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN D DOYLE NP (OWNWER/PROVIDER)
(609) 200-5117
Entity
Organization
Contact information
Practice address
1420 S NEW RD, PLEASANTVILLE, NJ 08232-3728
(609) 200-5117
(609) 939-3671
Mailing address
1420 S NEW RD, PLEASANTVILLE, NJ 08232-3728
(609) 200-5117
(609) 939-3671
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0673218
—
NJ
01
—
1029561
BEACONHORIZON
NJ
01
—
2105250
WELLCARE
—
01
—
601369570
MAGELLAN
NJ
Enumeration date
02/14/2019
Last updated
05/20/2022
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