Provider Demographics
NPI:1710630454
Name:MENTAL WELLNESS MONTCLAIR, LLC
Entity Type:Organization
Organization Name:MENTAL WELLNESS MONTCLAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALI STROPE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-745-2711
Mailing Address - Street 1:37 BROOKFIELD RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1301
Mailing Address - Country:US
Mailing Address - Phone:973-747-7594
Mailing Address - Fax:
Practice Address - Street 1:325 CLAREMONT AVE STE 5
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2218
Practice Address - Country:US
Practice Address - Phone:973-747-7594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty