Healthcare Provider Details

I. General information

NPI: 1396516977
Provider Name (Legal Business Name): MAVIDA CARE GROUP OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 ROUTE 66 STE 150
NEPTUNE NJ
07753-2645
US

IV. Provider business mailing address

5120 WOODLEY AVE
ENCINO CA
91436-1443
US

V. Phone/Fax

Practice location:
  • Phone: 628-432-7476
  • Fax: 888-385-7037
Mailing address:
  • Phone: 628-432-7476
  • Fax: 888-385-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH ORECK
Title or Position: CEO/PSYCHIATRIST
Credential: MD
Phone: 628-432-7476