Healthcare Provider Details

I. General information

NPI: 1780502757
Provider Name (Legal Business Name): PSYCHORA BEHAVIORAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 MCWHORTER ST RETAIL 1B
NEWARK NJ
07105
US

IV. Provider business mailing address

229 MCWHORTER ST RETAIL 1B
NEWARK NJ
07105
US

V. Phone/Fax

Practice location:
  • Phone: 929-335-3018
  • Fax:
Mailing address:
  • Phone: 929-335-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER A SANTOS
Title or Position: PARTNER
Credential: LPC
Phone: 929-335-3081