Healthcare Provider Details

I. General information

NPI: 1013784446
Provider Name (Legal Business Name): MENTAL FLEX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 CRESCENT AVE
WOODBRIDGE NJ
07095-3608
US

IV. Provider business mailing address

154 CRESCENT AVE
WOODBRIDGE NJ
07095-3608
US

V. Phone/Fax

Practice location:
  • Phone: 732-860-8732
  • Fax:
Mailing address:
  • Phone: 732-860-8732
  • 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: MRS. KRISTEN DEEKEN
Title or Position: CO-OWNER
Credential: APN
Phone: 732-492-8976