Healthcare Provider Details

I. General information

NPI: 1083531099
Provider Name (Legal Business Name): HEALING REIMAGINED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 ROUTE 35 # 321 (TELEHEALTH ONLY)
HAZLET NJ
07730-1505
US

IV. Provider business mailing address

3036 ROUTE 35 # 321
HAZLET NJ
07730-1505
US

V. Phone/Fax

Practice location:
  • Phone: 732-630-5968
  • Fax:
Mailing address:
  • Phone: 732-630-5968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MACKANIC
Title or Position: OWNER
Credential: LCSW, LCADC
Phone: 732-630-5968