Healthcare Provider Details

I. General information

NPI: 1457045320
Provider Name (Legal Business Name): NOVA PAX WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DELAWARE AVE
ROEBLING NJ
08554-1904
US

IV. Provider business mailing address

1208 JACKSONVILLE SMITHVILLE RD
BORDENTOWN NJ
08505-4009
US

V. Phone/Fax

Practice location:
  • Phone: 949-289-1273
  • Fax:
Mailing address:
  • Phone: 949-289-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. CLARENCE CUTSFORTH
Title or Position: FOUNDER/DIRECTOR
Credential: BCDFM
Phone: 949-289-1273