Healthcare Provider Details

I. General information

NPI: 1972132694
Provider Name (Legal Business Name): PATHS TO HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 04/04/2020
Certification Date: 04/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 PARKWAY AVE STE A1
EWING NJ
08618-2704
US

IV. Provider business mailing address

795 PARKWAY AVE STE A1
EWING NJ
08618-2704
US

V. Phone/Fax

Practice location:
  • Phone: 609-672-1385
  • Fax: 609-939-0700
Mailing address:
  • Phone: 609-672-1385
  • Fax: 609-939-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARISA OSEI
Title or Position: MANAGER
Credential:
Phone: 609-338-2244