Healthcare Provider Details

I. General information

NPI: 1316793078
Provider Name (Legal Business Name): COGNITIVEWORKS INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 07/01/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 GRAND AVE
ATLANTIC HIGHLANDS NJ
07716-1347
US

IV. Provider business mailing address

PO BOX 194
BROOKSIDE NJ
07926-0194
US

V. Phone/Fax

Practice location:
  • Phone: 973-214-8073
  • Fax:
Mailing address:
  • Phone: 973-214-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBIN HEDEMAN
Title or Position: PARTNER
Credential: OT MHA
Phone: 973-214-8073