Healthcare Provider Details

I. General information

NPI: 1881347003
Provider Name (Legal Business Name): CESSWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 LAUREL BROOK RD.
MONTVALE NJ
07645
US

IV. Provider business mailing address

175 KINDERKAMACK RD # 1011
PARK RIDGE NJ
07656-1335
US

V. Phone/Fax

Practice location:
  • Phone: 551-497-1964
  • Fax:
Mailing address:
  • Phone: 551-497-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN THOMAS MAGGIO JR.
Title or Position: DIRECTOR
Credential: LCADC, LAC
Phone: 551-497-1964