Healthcare Provider Details

I. General information

NPI: 1265246367
Provider Name (Legal Business Name): A MINDFUL JOURNEY MWD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 JORDAN CT
MAHWAH NJ
07430-3818
US

IV. Provider business mailing address

2151 JORDAN CT
MAHWAH NJ
07430-3818
US

V. Phone/Fax

Practice location:
  • Phone: 973-885-3004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MAKEDA WOODS-DEANS
Title or Position: CEO
Credential: LCSW
Phone: 201-560-6958