Healthcare Provider Details

I. General information

NPI: 1578031787
Provider Name (Legal Business Name): CENTER FOR EMOTIONAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W FRONT ST
RED BANK NJ
07701-1155
US

IV. Provider business mailing address

642 WESTON DR
TOMS RIVER NJ
08755-3271
US

V. Phone/Fax

Practice location:
  • Phone: 732-379-1715
  • Fax:
Mailing address:
  • Phone: 732-379-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN WASHBURN
Title or Position: OWNER
Credential:
Phone: 732-379-1715