=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568140838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEADSTOGETHER PSYCHE SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2023
-----------------------------------------------------
Last Update Date | 09/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 193 AVON AVE
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-337-2207
-----------------------------------------------------
Fax | 732-623-9654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 ROUTE 22 STE 2
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07081-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-337-2207
-----------------------------------------------------
Fax | 732-623-9654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC; FNP-BC
-----------------------------------------------------
Name | MS. LINDA NANA-POKUA OPPONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-318-8007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------