MEDICARE: GENERATIONAL WELLNESS CENTER

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1740123264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONAL WELLNESS CENTER

Provider Business Mailing Address
First Line	:	971 US HIGHWAY 202 N STE 4143
Second Line	:
City	:	BRANCHBURG
State	:	NJ
Zip	:	08876-3757
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 US HIGHWAY 202 N STE 4143
Second Line	:
City	:	BRANCHBURG
State	:	NJ
Zip	:	08876-3757
Country	:	US
Telephone Number	:	845-600-0640
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	CHANILL MEDINA
Credential	:	LMFT
Telephone Number	:	551-815-2561

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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