Healthcare Provider Details

I. General information

NPI: 1346183555
Provider Name (Legal Business Name): MARIAH O MAYERS WYNN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S KINDERKAMACK RD
MONTVALE NJ
07645-2128
US

IV. Provider business mailing address

783 COLUMBIA ST APT B
NEW MILFORD NJ
07646-6031
US

V. Phone/Fax

Practice location:
  • Phone: 201-982-3846
  • Fax:
Mailing address:
  • Phone: 201-478-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00942900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: