Provider Demographics
NPI:1992390496
Name:SANA MENTAL WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SANA MENTAL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ACS
Authorized Official - Phone:201-952-6404
Mailing Address - Street 1:69 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1813
Mailing Address - Country:US
Mailing Address - Phone:201-952-6404
Mailing Address - Fax:
Practice Address - Street 1:961 TEANECK ROAD
Practice Address - Street 2:DOOR 10, SUITE 1
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-952-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty