Healthcare Provider Details

I. General information

NPI: 1215848437
Provider Name (Legal Business Name): CEAN WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER RD STE 32
EDGEWATER NJ
07020-1149
US

IV. Provider business mailing address

244 6TH AVE W
NEWARK NJ
07107-2277
US

V. Phone/Fax

Practice location:
  • Phone: 201-373-6947
  • Fax:
Mailing address:
  • Phone: 201-281-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: