Provider Demographics
NPI:1811413883
Name:BEACON OF WELLNESS, INCORPORATED
Entity type:Organization
Organization Name:BEACON OF WELLNESS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADINAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN-DAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-784-4682
Mailing Address - Street 1:1636-44 ROUTE 38, BEACON OF WELLNESS, INC.
Mailing Address - Street 2:#334
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048
Mailing Address - Country:US
Mailing Address - Phone:609-784-4682
Mailing Address - Fax:609-699-6744
Practice Address - Street 1:40 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-2011
Practice Address - Country:US
Practice Address - Phone:609-784-4682
Practice Address - Fax:609-699-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05979800101YM0800X
NJ44SL06293100251S00000X
NJ44SL06288800251S00000X
NJ44SC05349200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0509060Medicaid
NJ1629476692OtherINDIVIDUAL NPI # FOR MADINAH BROWN-DAY