MEDICARE: UNA VITA SUPPORT BROKERAGE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1720682792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNA VITA SUPPORT BROKERAGE, LLC

Provider Business Mailing Address
First Line	:	3490 US HIGHWAY 1 STE 11
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5920
Country	:	US
Telephone Number	:	609-775-9067
Fax Number	:

Provider Business Practice Location Address
First Line	:	3490 US HIGHWAY 1 STE 11
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5920
Country	:	US
Telephone Number	:	609-775-9067
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JENNIFER ELIZABETH YOUNG
Credential	:	LSC
Telephone Number	:	609-651-9218

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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