Provider Demographics
NPI:1356054266
Name:ELITE MENTAL WELLNESS
Entity type:Organization
Organization Name:ELITE MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BOCKARIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-562-1446
Mailing Address - Street 1:5 HOWELL PL
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2551
Mailing Address - Country:US
Mailing Address - Phone:856-562-1446
Mailing Address - Fax:
Practice Address - Street 1:5 HOWELL PL
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2551
Practice Address - Country:US
Practice Address - Phone:856-562-1446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health