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General NPI Number Information
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NPI Number | 1053746461
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Entity Type | Organization
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Legal Business Name | ATLANTIC FAMILY WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 222 SERPENTINE DR
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City | BAYVILLE
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State | NJ
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Zip | 08721-3227
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Country | US
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Telephone | 732-801-4505
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Fax | 732-269-8385
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Provider Business Mailing Address
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Address Line | 267 CYPRESS DR
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City | BAYVILLE
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State | NJ
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Zip | 08721-3110
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Country | US
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Telephone | 732-801-4505
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Fax | 732-269-8385
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Authorized Official
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Title or Position | CEO
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Name | DR. BETTY JARUSIEWICZ
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Credential | PHD
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Telephone | 732-801-4505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00119700
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License Number State | NJ
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