Healthcare Provider Details

I. General information

NPI: 1689521007
Provider Name (Legal Business Name): NEEMA A MBONELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 POMPTON AVE STE B1
CEDAR GROVE NJ
07009-1213
US

IV. Provider business mailing address

141 E PIERREPONT AVE
RUTHERFORD NJ
07070-2417
US

V. Phone/Fax

Practice location:
  • Phone: 833-937-2724
  • Fax:
Mailing address:
  • Phone: 201-220-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00948500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: