Healthcare Provider Details

I. General information

NPI: 1841100971
Provider Name (Legal Business Name): WILDE HEART THERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8B COLFAX AVE
POMPTON LAKES NJ
07442-1710
US

IV. Provider business mailing address

24 N STILES CT
POMPTON LAKES NJ
07442-2216
US

V. Phone/Fax

Practice location:
  • Phone: 201-835-8335
  • Fax:
Mailing address:
  • Phone: 201-835-8335
  • 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: GINA DINIRO
Title or Position: CEO
Credential: LCSW
Phone: 201-835-8335