=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619416682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A PATH OF WELLNESS COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2017
-----------------------------------------------------
Last Update Date | 02/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 THOMAS RD
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-670-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 THOMAS RD
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-670-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SOCIAL WORKER
-----------------------------------------------------
Name | MS. KRISTINE BERLOWITZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 973-670-1414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 44SC05450400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------