Provider Demographics
NPI:1720682792
Name:UNA VITA SUPPORT BROKERAGE, LLC
Entity Type:Organization
Organization Name:UNA VITA SUPPORT BROKERAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LSC
Authorized Official - Phone:609-651-9218
Mailing Address - Street 1:3490 US HIGHWAY 1 STE 11
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5920
Mailing Address - Country:US
Mailing Address - Phone:609-775-9067
Mailing Address - Fax:
Practice Address - Street 1:3490 US HIGHWAY 1 STE 11
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5920
Practice Address - Country:US
Practice Address - Phone:609-775-9067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty