Provider Demographics
NPI:1679080469
Name:BEHAVIORAL WELLNESS CONNECTION BE WELL CONNECT
Entity Type:Organization
Organization Name:BEHAVIORAL WELLNESS CONNECTION BE WELL CONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DRNP
Authorized Official - Phone:609-844-0452
Mailing Address - Street 1:P.O. 6573
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-6573
Mailing Address - Country:US
Mailing Address - Phone:609-844-0452
Mailing Address - Fax:609-844-0518
Practice Address - Street 1:22 GORDON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-844-0452
Practice Address - Fax:609-844-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25NJ00323400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty