Healthcare Provider Details

I. General information

NPI: 1104260538
Provider Name (Legal Business Name): KWENYAN AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 LOWER FERRY RD SUITE#1
EWING NJ
08628-3525
US

IV. Provider business mailing address

860 LOWER FERRY RD SUITE#1
EWING NJ
08628-3525
US

V. Phone/Fax

Practice location:
  • Phone: 609-403-8740
  • Fax: 609-403-8746
Mailing address:
  • Phone: 609-403-8740
  • Fax: 609-403-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL E CASSELL
Title or Position: PRESIDENT/CEO
Credential: PHD
Phone: 609-403-8740