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General NPI Number Information
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NPI Number | 1427960905
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Entity Type | Organization
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Legal Business Name | BECERRA WELLNESS LLC
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 717 N BEERS ST STE 12B
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City | HOLMDEL
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State | NJ
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Zip | 07733-1524
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Country | US
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Telephone | 318-200-0573
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Fax | 318-202-8229
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Provider Business Mailing Address
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Address Line | 1 GATEWAY CTR STE 2600
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City | NEWARK
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State | NJ
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Zip | 07102-5323
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Country | US
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Telephone | 318-200-0573
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Fax | 318-202-8229
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL BECERRA
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Credential | LPC
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Telephone | 318-200-0573
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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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