Healthcare Provider Details

I. General information

NPI: 1558226092
Provider Name (Legal Business Name): LUMINATE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 JACKSON DR FL 1
CRANFORD NJ
07016-3609
US

IV. Provider business mailing address

20 JACKSON DR FL 1
CRANFORD NJ
07016-3609
US

V. Phone/Fax

Practice location:
  • Phone: 908-469-8484
  • Fax:
Mailing address:
  • Phone: 908-469-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AZUKA OFODIKE
Title or Position: APN
Credential:
Phone: 862-215-1230