Provider Demographics
NPI:1669837811
Name:SAGE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SAGE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELWEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-505-4612
Mailing Address - Street 1:1901 LAKEWOOD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1211
Mailing Address - Country:US
Mailing Address - Phone:732-505-4612
Mailing Address - Fax:732-505-4671
Practice Address - Street 1:1901 LAKEWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1211
Practice Address - Country:US
Practice Address - Phone:732-505-4612
Practice Address - Fax:732-505-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO55189001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty