Healthcare Provider Details

I. General information

NPI: 1245965862
Provider Name (Legal Business Name): ELITE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 PARKWAY AVE UNIT 2
EWING NJ
08618-2704
US

IV. Provider business mailing address

795 PARKWAY AVE UNIT 2
EWING NJ
08618-2704
US

V. Phone/Fax

Practice location:
  • Phone: 862-781-3499
  • Fax: 862-781-3501
Mailing address:
  • Phone: 862-781-3499
  • Fax: 862-781-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONICA ARIYO
Title or Position: OWNER
Credential:
Phone: 862-781-3499