Healthcare Provider Details

I. General information

NPI: 1235720970
Provider Name (Legal Business Name): EMBODIED HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 REGENT RD
CHERRY HILL NJ
08003-1440
US

IV. Provider business mailing address

28 REGENT RD
CHERRY HILL NJ
08003-1440
US

V. Phone/Fax

Practice location:
  • Phone: 607-342-2935
  • Fax: 856-751-7415
Mailing address:
  • Phone: 607-342-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HEATHER SKARBEK
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 607-342-2935