Healthcare Provider Details

I. General information

NPI: 1013530708
Provider Name (Legal Business Name): BUG AND BEAR DESIGNS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 BLOOMFIELD AVE STE 2
MONTCLAIR NJ
07042-3416
US

IV. Provider business mailing address

102 N MOUNTAIN AVE
MONTCLAIR NJ
07042-2350
US

V. Phone/Fax

Practice location:
  • Phone: 561-542-0273
  • Fax:
Mailing address:
  • Phone: 561-542-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACEY KIRSCHNER KAYNE
Title or Position: OWNER
Credential:
Phone: 561-542-0273