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General NPI Number Information
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NPI Number | 1881276442
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Entity Type | Organization
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Legal Business Name | MINDFUL THERAPY OF MONMOUTH COUNTY LLC
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 30 FRENEAU AVE BLDG A
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City | MATAWAN
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State | NJ
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Zip | 07747-3390
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Country | US
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Telephone | 732-705-1561
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Fax | 732-791-9057
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Provider Business Mailing Address
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Address Line | 30 FRENEAU AVE BLDG A
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City | MATAWAN
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State | NJ
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Zip | 07747-3390
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Country | US
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Telephone | 732-705-1561
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Fax | 732-791-9057
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NICOLE RACHEL WEGWEISER
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Credential | LCSW
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Telephone | 732-705-1561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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