Healthcare Provider Details

I. General information

NPI: 1427960905
Provider Name (Legal Business Name): BECERRA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N BEERS ST STE 12B
HOLMDEL NJ
07733-1524
US

IV. Provider business mailing address

1 GATEWAY CTR STE 2600
NEWARK NJ
07102-5323
US

V. Phone/Fax

Practice location:
  • Phone: 318-200-0573
  • Fax: 318-202-8229
Mailing address:
  • Phone: 318-200-0573
  • Fax: 318-202-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BECERRA
Title or Position: OWNER
Credential: LPC
Phone: 318-200-0573