Healthcare Provider Details

I. General information

NPI: 1548179047
Provider Name (Legal Business Name): TRAUMA INFORMED CARE (TIC) WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 FAIRMOUNT AVE
NEWARK NJ
07103-2433
US

IV. Provider business mailing address

164 FAIRMOUNT AVE
NEWARK NJ
07103-2433
US

V. Phone/Fax

Practice location:
  • Phone: 201-310-9870
  • Fax:
Mailing address:
  • Phone: 201-310-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MOISE
Title or Position: CEO
Credential: LCSW
Phone: 201-310-9870