Healthcare Provider Details

I. General information

NPI: 1699685214
Provider Name (Legal Business Name): COMPOSED MIND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 NJ 34
MANASQUAN NJ
08736
US

IV. Provider business mailing address

104 NEW YORK AVE
POINT PLEASANT BEACH NJ
08742-3332
US

V. Phone/Fax

Practice location:
  • Phone: 732-682-7866
  • Fax:
Mailing address:
  • Phone: 732-682-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LEO BEYDA
Title or Position: OWNER
Credential:
Phone: 732-682-7866