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General NPI Number Information
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NPI Number | 1457045320
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Entity Type | Organization
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Legal Business Name | NOVA PAX WELLNESS LLC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 501 DELAWARE AVE
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City | ROEBLING
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State | NJ
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Zip | 08554-1904
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Country | US
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Telephone | 949-289-1273
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 JACKSONVILLE SMITHVILLE RD
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City | BORDENTOWN
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State | NJ
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Zip | 08505-4009
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Country | US
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Telephone | 949-289-1273
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Fax |
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Authorized Official
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Title or Position | FOUNDER/DIRECTOR
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Name | DR. CLARENCE CUTSFORTH
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Credential | BCDFM
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Telephone | 949-289-1273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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