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General NPI Number Information
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NPI Number | 1063279040
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Entity Type | Organization
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Legal Business Name | BYRD'S OF PARADISE
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 5016 BERGENLINE AVE UNIT 2
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5522
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Country | US
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Telephone | 856-383-6253
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Fax |
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Provider Business Mailing Address
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Address Line | 5016 BERGENLINE AVE UNIT 2
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5522
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Country | US
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Telephone | 856-383-6253
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JAMAL STEPHON STEPHENS
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Credential |
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Telephone | 856-383-6253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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