| Sanctuary For Wellness | |
|
18-20 Lackawanna Plz Montclair NJ 07042-3642 | |
| (973) 459-0964 | |
| Not Available |
| Full Name | Sanctuary For Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 18-20 Lackawanna Plz, Montclair, New Jersey |
| Authorized Official Name and Position | Maritza Soto (OWNER) |
| Authorized Official Contact | 9734590964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanctuary For Wellness Po Box 185 Verona NJ 07044-0185 Ph: (973) 459-0964 | Sanctuary For Wellness 18-20 Lackawanna Plz Montclair NJ 07042-3642 Ph: (973) 459-0964 |
| NPI Number | 1497402309 |
|---|---|
| Provider Enumeration Date | 03/10/2022 |
| Last Update Date | 03/10/2022 |
| Certification Date | 03/10/2022 |
| Medicare PECOS PAC ID | 7618357435 |
|---|---|
| Medicare Enrollment ID | O20220711000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497402309 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Maritza Soto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336346329 PECOS PAC ID: 1355521675 Enrollment ID: I20220711000431 |
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