Healthcare Provider Details

I. General information

NPI: 1730024837
Provider Name (Legal Business Name): ALICE PEI YU WEN MA, NCC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MILLBURN AVE STE 104
MILLBURN NJ
07041-1919
US

IV. Provider business mailing address

116 MILLBURN AVE STE 104
MILLBURN NJ
07041-1919
US

V. Phone/Fax

Practice location:
  • Phone: 908-364-7611
  • Fax:
Mailing address:
  • Phone: 908-364-7611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00830200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: