Healthcare Provider Details

I. General information

NPI: 1467088229
Provider Name (Legal Business Name): SERENITY MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N MAIN ST
MILLTOWN NJ
08850-1549
US

IV. Provider business mailing address

28 N MAIN ST
MILLTOWN NJ
08850-1549
US

V. Phone/Fax

Practice location:
  • Phone: 732-220-1300
  • Fax: 732-514-1600
Mailing address:
  • Phone: 732-220-1300
  • Fax: 732-514-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE LYNN HARRIS-KUIPER
Title or Position: THERAPIST / OWNER
Credential: LPC, LCADC, ACS
Phone: 732-781-5752