=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205521093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUIDED STRENGTH PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2023
-----------------------------------------------------
Last Update Date | 08/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1913 ATLANTIC AVE STE 160
-----------------------------------------------------
City | MANASQUAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08736-1064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-487-1808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1913 ATLANTIC AVE STE 160
-----------------------------------------------------
City | MANASQUAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08736-1064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | REBECCA JACKWICZ
-----------------------------------------------------
Credential | APN
-----------------------------------------------------
Telephone | 973-978-7220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------