Healthcare Provider Details

I. General information

NPI: 1720408099
Provider Name (Legal Business Name): BEHAVIOR WELLNESS CENTER AND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ENGLE ST SUITE 203
ENGLEWOOD NJ
07631-2936
US

IV. Provider business mailing address

15 ENGLE ST SUITE 203
ENGLEWOOD NJ
07631-2936
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-1224
  • Fax: 201-894-4720
Mailing address:
  • Phone: 201-894-1224
  • Fax: 201-894-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberSI02555
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberSI02555
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSI02555
License Number StateNJ

VIII. Authorized Official

Name: DR. LUCIEN DUQUETTE
Title or Position: PSYCHOLOGIST OWNER
Credential: PHD
Phone: 201-894-1224