Provider Demographics
NPI:1447033907
Name:MYSTEPRO
Entity type:Organization
Organization Name:MYSTEPRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MYSTEPRO
Authorized Official - Prefix:MS
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:CYISE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LCADC
Authorized Official - Phone:201-780-6142
Mailing Address - Street 1:37 EDGERTON TER
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-3302
Mailing Address - Country:US
Mailing Address - Phone:201-780-6142
Mailing Address - Fax:201-502-8250
Practice Address - Street 1:75 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2555
Practice Address - Country:US
Practice Address - Phone:201-451-5425
Practice Address - Fax:201-502-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children