Provider Demographics
NPI:1881276442
Name:MINDFUL THERAPY OF MONMOUTH COUNTY LLC
Entity type:Organization
Organization Name:MINDFUL THERAPY OF MONMOUTH COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:WEGWEISER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-705-1561
Mailing Address - Street 1:30 FRENEAU AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3390
Mailing Address - Country:US
Mailing Address - Phone:732-705-1561
Mailing Address - Fax:732-791-9057
Practice Address - Street 1:30 FRENEAU AVE BLDG A
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3390
Practice Address - Country:US
Practice Address - Phone:732-705-1561
Practice Address - Fax:732-791-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1215185004OtherNPI