MEDICARE: EBONYS WELL OF HOPE 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1831052620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBONYS WELL OF HOPE LLC

Provider Business Mailing Address
First Line	:	200 MOUNT PLEASANT AVE APT B11
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-4053
Country	:	US
Telephone Number	:	347-871-4613
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MOUNT PLEASANT AVE APT B11
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-4053
Country	:	US
Telephone Number	:	347-871-4613
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ONITKAA ZENNONBIA GALBREATH
Credential	:	LCSW
Telephone Number	:	201-668-8574

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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