| Mind Body Recovery Center, Llc | |
|
12 N State Rt 17 Suite 313 Paramus NJ 07652-2644 | |
| (201) 543-3935 | |
| (201) 226-1141 |
| Full Name | Mind Body Recovery Center, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12 N State Rt 17, Paramus, New Jersey |
| Authorized Official Name and Position | Rebecca Henriquez (PRESIDENT) |
| Authorized Official Contact | 2015433935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Recovery Center, Llc 12 N State Rt 17 Suite 313 Paramus NJ 07652-2644 Ph: (201) 543-3935 | Mind Body Recovery Center, Llc 12 N State Rt 17 Suite 313 Paramus NJ 07652-2644 Ph: (201) 543-3935 |
| NPI Number | 1699063362 |
|---|---|
| Provider Enumeration Date | 07/15/2011 |
| Last Update Date | 10/22/2015 |
| Medicare PECOS PAC ID | 8527369321 |
|---|---|
| Medicare Enrollment ID | O20151221002317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699063362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 44SCO5258800 (New Jersey) | Primary |
| Provider Name | Rebecca Henriquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881861698 PECOS PAC ID: 5496914756 Enrollment ID: I20120307000101 |
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