| Kwenyan Professional Health Services, Llc | |
|
200 South St New Providence NJ 07974-2151 | |
| (908) 516-2338 | |
| (866) 376-8262 |
| Full Name | Kwenyan Professional Health Services, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 200 South St, New Providence, New Jersey |
| Authorized Official Name and Position | Dr. Daniel Estrada Cassell, Ph.d., Mph (PRESIDENT/CEO: ADMINISTRATOR) |
| Authorized Official Contact | 2154323702 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kwenyan Professional Health Services, Llc 19 Hutton Ave West Orange NJ 07052-4803 Ph: (609) 284-5822 | Kwenyan Professional Health Services, Llc 200 South St New Providence NJ 07974-2151 Ph: (908) 516-2338 |
| NPI Number | 1609335736 |
|---|---|
| Provider Enumeration Date | 03/18/2019 |
| Last Update Date | 03/18/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609335736 | NPI | - | NPPES |
| 101950404 | Other | NJ | NJ OFFICE OF LICENSING: OUTPATIENT MENTAL HEALTH SERVICES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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