Healthcare Provider Details

I. General information

NPI: 1275115131
Provider Name (Legal Business Name): FULL SPECTRUM THERAPY PARTNERS II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 WHITEHORSE MERCERVILLE RD STE 205
HAMILTON NJ
08619-1953
US

IV. Provider business mailing address

2312 WHITEHORSE MERCERVILLE RD STE 205
HAMILTON NJ
08619-1953
US

V. Phone/Fax

Practice location:
  • Phone: 609-643-9077
  • Fax: 609-482-5855
Mailing address:
  • Phone: 609-643-9077
  • Fax: 609-482-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE KRIES-WYSZYNSKI
Title or Position: CEO
Credential:
Phone: 609-795-8511