Healthcare Provider Details

I. General information

NPI: 1366019275
Provider Name (Legal Business Name): EMPOWERED VOICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WATCHUNG AVE STE 314
MONTCLAIR NJ
07043-1337
US

IV. Provider business mailing address

41 WATCHUNG AVE STE 314
MONTCLAIR NJ
07043-1337
US

V. Phone/Fax

Practice location:
  • Phone: 301-200-1884
  • Fax:
Mailing address:
  • Phone: 301-200-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY GENTRY
Title or Position: OWNER
Credential: MA, LPC
Phone: 631-617-1487