Healthcare Provider Details

I. General information

NPI: 1447075445
Provider Name (Legal Business Name): COOPERATIVE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 ROUTE 47 S
RIO GRANDE NJ
08242-1608
US

IV. Provider business mailing address

1078 ROUTE 47 S
RIO GRANDE NJ
08242-1608
US

V. Phone/Fax

Practice location:
  • Phone: 609-408-6565
  • Fax:
Mailing address:
  • Phone: 609-408-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA WELLS-MANLANDRO
Title or Position: MEMBER
Credential: LCSW, LCADC
Phone: 609-408-6565