Provider Demographics
NPI:1720408099
Name:BEHAVIOR WELLNESS CENTER AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BEHAVIOR WELLNESS CENTER AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-894-1224
Mailing Address - Street 1:15 ENGLE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2936
Mailing Address - Country:US
Mailing Address - Phone:201-894-1224
Mailing Address - Fax:201-894-4720
Practice Address - Street 1:15 ENGLE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2936
Practice Address - Country:US
Practice Address - Phone:201-894-1224
Practice Address - Fax:201-894-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI02555103T00000X, 103TA0400X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty