Provider Demographics
NPI:1245737824
Name:YOUTH AND FAMILY WELLNESS
Entity Type:Organization
Organization Name:YOUTH AND FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COUNSELOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:RWIVANGA
Authorized Official - Last Name:RURANGA
Authorized Official - Suffix:
Authorized Official - Credentials:MSEDLPC
Authorized Official - Phone:973-821-4702
Mailing Address - Street 1:277 N WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1447
Mailing Address - Country:US
Mailing Address - Phone:973-821-4702
Mailing Address - Fax:973-275-9224
Practice Address - Street 1:76 S ORANGE AVE STE 206B
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1923
Practice Address - Country:US
Practice Address - Phone:973-821-4702
Practice Address - Fax:973-275-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00024200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health