Provider Demographics
NPI:1790521391
Name:SELF AND WELLNESS, LLC
Entity type:Organization
Organization Name:SELF AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALMIR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:914-562-9688
Mailing Address - Street 1:349 SAINT CLOUD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2517
Mailing Address - Country:US
Mailing Address - Phone:914-562-9688
Mailing Address - Fax:
Practice Address - Street 1:5 GREENTREE CENTRE
Practice Address - Street 2:SUITE 104
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:914-361-5991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)