Provider Demographics
NPI:1952665671
Name:NEUROBEHAVIORAL WELLNESS CENTER
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:ARCARI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:856-975-6279
Mailing Address - Street 1:1630 ROUTE 322
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOOLWICH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-3701
Mailing Address - Country:US
Mailing Address - Phone:856-975-6279
Mailing Address - Fax:856-975-6281
Practice Address - Street 1:1630 ROUTE 322
Practice Address - Street 2:SUITE C
Practice Address - City:WOOLWICH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-3701
Practice Address - Country:US
Practice Address - Phone:856-975-6279
Practice Address - Fax:856-975-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00451500103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962696732OtherINDIVIDUAL NPI