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General NPI Number Information
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NPI Number | 1972150159
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Entity Type | Organization
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Legal Business Name | LIVING WATER BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 335 KLAGG AVE
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City | TRENTON
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State | NJ
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Zip | 08638-4419
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Country | US
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Telephone | 609-228-6258
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Fax | 609-423-0210
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Provider Business Mailing Address
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Address Line | 335 KLAGG AVE
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City | TRENTON
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State | NJ
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Zip | 08638-4419
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Country | US
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Telephone | 609-228-6258
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Fax | 609-423-0210
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAMSI NWANKWOR
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Credential |
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Telephone | 609-228-6258
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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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