Healthcare Provider Details

I. General information

NPI: 1821208158
Provider Name (Legal Business Name): COMPREHENSIVE PSYCHOLOGICAL AND WELLNESS CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MAIN ST UNIT F
FORKED RIVER NJ
08731-4641
US

IV. Provider business mailing address

424 S MAIN ST UNIT F
FORKED RIVER NJ
08731-4641
US

V. Phone/Fax

Practice location:
  • Phone: 609-693-4343
  • Fax:
Mailing address:
  • Phone: 609-693-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number35SI00429000
License Number StateNJ

VIII. Authorized Official

Name: DR. LISA MARIE GRANATO
Title or Position: PHYSICIAN
Credential: PSY.D
Phone: 609-693-4343