Healthcare Provider Details

I. General information

NPI: 1598300410
Provider Name (Legal Business Name): NILSY MUNOZ AS COUNSELING MINIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REVELATION UNIVERSITY WELLNESS UNIT 307 MONROE ST #4
PASSAIC NJ
07055
US

IV. Provider business mailing address

462 E 35TH ST
PATERSON NJ
07504-1714
US

V. Phone/Fax

Practice location:
  • Phone: 973-855-9147
  • Fax:
Mailing address:
  • Phone: 973-855-9147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberCPE-2040NM8245
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: