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General NPI Number Information
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NPI Number | 1851246672
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Entity Type | Organization
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Legal Business Name | BRIGHTPATH SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 25 HIGH ST APT C1
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2452
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Country | US
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Telephone | 315-415-7148
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Fax |
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Provider Business Mailing Address
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Address Line | 25 HIGH ST APT C1
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2452
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Country | US
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Telephone | 315-415-7148
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS KEZIA WALLERSON
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Credential |
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Telephone | 315-415-7148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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