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General NPI Number Information
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NPI Number | 1700678901
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Entity Type | Organization
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Legal Business Name | RADIANCE PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 566-568 S 18TH ST FL 1
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City | NEWARK
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State | NJ
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Zip | 07103-1147
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Country | US
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Telephone | 862-423-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 566-568 S 18TH ST FL 1
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City | NEWARK
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State | NJ
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Zip | 07103-1147
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Country | US
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Telephone | 862-423-7333
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Fax |
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Authorized Official
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Title or Position | DNP/OWNER
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Name | MRS. VICTORIA O OLANIYAN
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Credential | DNP, APN, PMHNP-BC
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Telephone | 862-423-7333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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