Provider Demographics
NPI:1174394712
Name:PSYCHTREAT LLC
Entity type:Organization
Organization Name:PSYCHTREAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BABAYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:PMNHP-BC
Authorized Official - Phone:347-322-6776
Mailing Address - Street 1:33 ANDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-1305
Mailing Address - Country:US
Mailing Address - Phone:347-322-6776
Mailing Address - Fax:
Practice Address - Street 1:33 ANDOVER AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-1305
Practice Address - Country:US
Practice Address - Phone:347-322-6776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty