Healthcare Provider Details

I. General information

NPI: 1053976332
Provider Name (Legal Business Name): BRIGHTER LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 RECKLESS PL
RED BANK NJ
07701-1750
US

IV. Provider business mailing address

47 RECKLESS PL
RED BANK NJ
07701-1750
US

V. Phone/Fax

Practice location:
  • Phone: 732-219-9002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE RICCIO-LYNCH
Title or Position: OWNER/LICENSED CLINICIAN
Credential:
Phone: 732-219-9002