Healthcare Provider Details

I. General information

NPI: 1619414885
Provider Name (Legal Business Name): BRAVE MINDS PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 PARK AVE SUITE 204
SCOTCH PLAINS NJ
07076-1754
US

IV. Provider business mailing address

567 PARK AVE SUITE 204
SCOTCH PLAINS NJ
07076-1754
US

V. Phone/Fax

Practice location:
  • Phone: 908-242-3634
  • Fax:
Mailing address:
  • Phone: 908-242-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00456800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. FAWN M MCNEIL-HABER
Title or Position: OWNER
Credential: PHD
Phone: 908-242-3634