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General NPI Number Information
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NPI Number | 1558741348
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Entity Type | Organization
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Legal Business Name | FAITHLIFT & HOPE, LLC
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 322 LIVINGSTON AVE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-3457
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Country | US
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Telephone | 732-202-5406
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Fax |
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Provider Business Mailing Address
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Address Line | 335 GEORGE STREET, SUITE 4 #307
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-3457
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Country | US
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Telephone | 732-202-5406
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Fax | 908-312-5076
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Authorized Official
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Title or Position | DIRECTOR OF MENTAL HEALTH SERVICES
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Name | DR. WANDA Y QUEZADA
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Credential | LPCC
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Telephone | 732-202-5406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NJ
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