Provider Demographics
NPI:1366908303
Name:CLINICAL SPECIALIST, LLC
Entity type:Organization
Organization Name:CLINICAL SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:609-200-5117
Mailing Address - Street 1:1420 S NEW RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3728
Mailing Address - Country:US
Mailing Address - Phone:609-200-5117
Mailing Address - Fax:609-939-3671
Practice Address - Street 1:1420 S NEW RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3728
Practice Address - Country:US
Practice Address - Phone:609-200-5117
Practice Address - Fax:609-939-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ601369570OtherMAGELLAN
2105250OtherWELLCARE
NJ0673218Medicaid
NJ1029561OtherBEACONHORIZON