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General NPI Number Information
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NPI Number | 1205312766
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Entity Type | Organization
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Legal Business Name | KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 291 PICKFORD AVE
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1626
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Country | US
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Telephone | 908-777-3744
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Fax | 908-777-3746
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Provider Business Mailing Address
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Address Line | 291 PICKFORD AVE
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1626
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Country | US
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Telephone | 908-777-3744
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Fax | 908-777-3746
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Authorized Official
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Title or Position | PRESIDENT/CEO: ADMINISTRATOR
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Name | DR. DR. DANIEL ESTRADA CASSELL, PH.D., MPH
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Credential | PH.D., MPH
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Telephone | 215-432-3702
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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 | 2000686
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 2000686
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License Number State | NJ
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