Healthcare Provider Details

I. General information

NPI: 1093365041
Provider Name (Legal Business Name): MARVELOUS ME THERAPY & SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 EVERGREEN PL
EAST ORANGE NJ
07018-2005
US

IV. Provider business mailing address

1632 BOGART AVE
BRONX NY
10462-4004
US

V. Phone/Fax

Practice location:
  • Phone: 646-645-6929
  • Fax: 347-402-1055
Mailing address:
  • Phone: 646-645-6929
  • Fax: 347-402-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAUREN SANDERS
Title or Position: PRESIDENT
Credential: MSED/TSSH
Phone: 646-645-6929