Healthcare Provider Details

I. General information

NPI: 1083591895
Provider Name (Legal Business Name): MPATH WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E MAIN ST # 101
FREEHOLD NJ
07728-2295
US

IV. Provider business mailing address

103 WALL ST
WEST LONG BRANCH NJ
07764-1774
US

V. Phone/Fax

Practice location:
  • Phone: 732-423-1839
  • Fax:
Mailing address:
  • Phone: 732-423-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIA E DODDS
Title or Position: COUNSELOR - PROFESSIONAL
Credential: LPC
Phone: 732-423-1839