Provider Demographics
NPI:1982221479
Name:RAMONA A CROFOOT, LLC DBA KALEIDOSCOPE TRANSFORMATIONS WELLNESS CENT
Entity Type:Organization
Organization Name:RAMONA A CROFOOT, LLC DBA KALEIDOSCOPE TRANSFORMATIONS WELLNESS CENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-575-3486
Mailing Address - Street 1:371 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-7393
Mailing Address - Country:US
Mailing Address - Phone:732-575-3486
Mailing Address - Fax:
Practice Address - Street 1:371 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7393
Practice Address - Country:US
Practice Address - Phone:732-575-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)