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General NPI Number Information
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NPI Number | 1639947922
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Entity Type | Organization
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Legal Business Name | MONTCLAIR BEHAVIORAL HEALTH & WELLNESS
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 103 PARK ST STE 2C
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2935
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Country | US
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Telephone | 973-791-7557
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Fax |
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Provider Business Mailing Address
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Address Line | 103 PARK ST STE 2C
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2935
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KERI WASSER
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Credential | MD
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Telephone | 973-791-7557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical 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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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