Healthcare Provider Details

I. General information

NPI: 1578456653
Provider Name (Legal Business Name): CLEAR MIND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 BLOY STREET
HILLSIDE NJ
07205-1734
US

IV. Provider business mailing address

532 BLOY STREET
HILLSIDE NJ
07205-1734
US

V. Phone/Fax

Practice location:
  • Phone: 908-251-9498
  • Fax:
Mailing address:
  • Phone: 908-251-9498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER LONGERGAN
Title or Position: AUTHORIZED OFFICIAL
Credential: LPC
Phone: 908-251-9498