Healthcare Provider Details

I. General information

NPI: 1033041462
Provider Name (Legal Business Name): EMBODIED AUTONOMY CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 ROUTE 40
MONROEVILLE NJ
08343
US

IV. Provider business mailing address

12 E HIGH ST
GLASSBORO NJ
08028-2520
US

V. Phone/Fax

Practice location:
  • Phone: 856-472-8186
  • Fax:
Mailing address:
  • Phone: 856-472-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSIKA NICOLE SZATNY
Title or Position: OWNER
Credential: LCSW
Phone: 856-472-8186