Provider Demographics
NPI:1083479786
Name:DTE WELLNESS LLC
Entity Type:Organization
Organization Name:DTE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DABEYRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES-ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-359-4081
Mailing Address - Street 1:7 STAFFORDSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1796
Mailing Address - Country:US
Mailing Address - Phone:646-359-4081
Mailing Address - Fax:
Practice Address - Street 1:15900 RIVERSIDE DR W APT 1A70
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1034
Practice Address - Country:US
Practice Address - Phone:914-348-1830
Practice Address - Fax:201-335-6548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty