Provider Demographics
NPI:1770214900
Name:COLLECTIVE WELLNESS SERVICES LTD
Entity Type:Organization
Organization Name:COLLECTIVE WELLNESS SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:973-339-7021
Mailing Address - Street 1:1253 SPRINGFIELD AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2931
Mailing Address - Country:US
Mailing Address - Phone:973-339-7021
Mailing Address - Fax:973-370-3355
Practice Address - Street 1:1253 SPRINGFIELD AVE STE 340
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-2931
Practice Address - Country:US
Practice Address - Phone:973-339-7021
Practice Address - Fax:973-370-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty