Provider Demographics
NPI:1790525384
Name:MWG EDUCATOR AND CLINICIAN LLC
Entity type:Organization
Organization Name:MWG EDUCATOR AND CLINICIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-720-9191
Mailing Address - Street 1:6 KILMER RD UNIT A114
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2432
Mailing Address - Country:US
Mailing Address - Phone:908-720-9191
Mailing Address - Fax:
Practice Address - Street 1:6 KILMER RD UNIT A114
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2432
Practice Address - Country:US
Practice Address - Phone:908-720-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty