| Comprehensive Psychological And Wellness Center,llc | |
|
424 S Main St Unit F Forked River NJ 08731-4641 | |
| (609) 693-4343 | |
| Not Available |
| Full Name | Comprehensive Psychological And Wellness Center,llc |
|---|---|
| Speciality | Psychologist |
| Location | 424 S Main St, Forked River, New Jersey |
| Authorized Official Name and Position | Lisa Marie Granato (PHYSICIAN) |
| Authorized Official Contact | 6096934343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Comprehensive Psychological And Wellness Center,llc 424 S Main St Unit F Forked River NJ 08731-4641 Ph: (609) 693-4343 | Comprehensive Psychological And Wellness Center,llc 424 S Main St Unit F Forked River NJ 08731-4641 Ph: (609) 693-4343 |
| NPI Number | 1821208158 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 03/22/2010 |
| Medicare PECOS PAC ID | 5890701528 |
|---|---|
| Medicare Enrollment ID | O20060303000461 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821208158 | NPI | - | NPPES |
| 2831657000 | Other | NJ | AMERIHEALTH GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | 35SI00429000 (New Jersey) | Primary |
| Provider Name | Lisa M Granato |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932142148 PECOS PAC ID: 5193746691 Enrollment ID: I20051220000322 |
| Provider Name | Melinda Mcgullam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629190525 PECOS PAC ID: 1153411616 Enrollment ID: I20071220000345 |
| Provider Name | Karen Mulgrum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821129354 PECOS PAC ID: 2264557602 Enrollment ID: I20100909000114 |
| Provider Name | Teresa L Mathis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245491604 PECOS PAC ID: 9739339839 Enrollment ID: I20121026000172 |
| Provider Name | Gary D Levine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861670283 PECOS PAC ID: 0648503938 Enrollment ID: I20190530002575 |
| Provider Name | Kelly J Dallessio |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1558614214 PECOS PAC ID: 9931550035 Enrollment ID: I20240112000888 |
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