Organization
ERIDIAN BEHAVIORAL HEALTH
Active
Parent organization
MERIDIAN HEALTH
Other names
Park Place
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERIDIAN HEALTH
Authorized official
MR. PETER E DOUGHERTY LCSW, LCADC (CLINICAL SUPERVISOR)
(732) 869-2773
Entity
Organization
Contact information
Practice address
1011 BOND ST, ASBURY PARK, NJ 07712-5939
(732) 859-1794
Mailing address
1011 BOND ST, ASBURY PARK, NJ 07712-5939
(732) 859-1794
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
37LC00188000
NJ
261QM0850X
Adult Mental Health Clinic/Center
Primary
44SC05427900
NJ
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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