Provider Demographics
NPI:1871872226
Name:SAMMARET BEHAVIORAL SERVICES PC
Entity type:Organization
Organization Name:SAMMARET BEHAVIORAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YETUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-494-4614
Mailing Address - Street 1:52 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3027
Mailing Address - Country:US
Mailing Address - Phone:973-494-4614
Mailing Address - Fax:
Practice Address - Street 1:225 MILLBURN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1737
Practice Address - Country:US
Practice Address - Phone:973-494-4614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08841500261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health