MEDICARE: ESSENCE OF LIFE THERAPEUTIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1124806013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENCE OF LIFE THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	7 DEMARET CT
Second Line	:
City	:	LITTLE EGG HARBOR TWP
State	:	NJ
Zip	:	08087-1808
Country	:	US
Telephone Number	:	609-857-1582
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 DEMARET CT
Second Line	:
City	:	LITTLE EGG HARBOR TWP
State	:	NJ
Zip	:	08087-1808
Country	:	US
Telephone Number	:	609-857-1582
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	TATIANA NEGRON
Credential	:
Telephone Number	:	732-795-5519

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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