KWENYAN PROFESSIONAL HEALTH SERVICES, LLC (NPI# 1205312766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205312766 |
| Entity Type | Organization |
| Organization Name | KWENYAN PROFESSIONAL HEALTH SERVICES, LLC |
| Other Organization Name | KWENYAN PROFESSIONAL HEALTH SERVICES, LLC |
| Practice Address |
291 Pickford Ave Phillipsburg NJ 08865-1626 |
| Practice Telephone | 9087773744 |
| Practice Fax Number | 9087773746 |
| Mailing Telephone | 9087773744 |
| Mailing Fax Number | 9087773746 |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2018-07-17 |
| Authorized Official Name | DR. DR. DANIEL ESTRADA CASSELL, PH.D., MPH (PRESIDENT/CEO: ADMINISTRATOR) |
| Authorized Official Telephone | 2154323702 |
| Authorized Official Credential | PH.D., MPH |
| Is Organization Subpart | Y |
| Parent Organization Name | KWENYAN PROFESSIONAL HEALTH SERVICES, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
2000686 | NJ | Behavioral Health & Social Service Providers |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
2000686 | NJ | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | ADDICTIONS SERVICES | 2000686 | 01 |
| Other Name | Type Code |
|---|---|
| Kwenyan Professional Health Services, LLC | Doing Business As Name - Organization |
| Kwenyan Professional Health Services, LLLC | Other Name - Individual/Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 19 Hutton Ave, West Orange, NJ 070524803 | 9736726900 | 8663768262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609335736 | Kwenyan Professional Health Services, LLC | Counselor | 200 South St, New Providence, NJ 07974-2151 | 2019-03-18 |
| 1003392374 | Kwenyan Professional Health Services, LLC | Clinic/Center | 291 Pickford Ave, Phillipsburg, NJ 08865-1626 | 2018-07-19 |
| 1285928457 | Kwenyan Professional Health Services, LLC | Clinic/Center | 60 Evergreen Pl, Suite 500, East Orange, NJ 07018-2106 | 2011-06-06 |
| 1326368267 | Kwenyan Professional Health Services, LLC | Clinic/Center | 60 Evergreen Pl, Suite 500, East Orange, NJ 07018-2106 | 2010-06-02 |
| 1457671372 | Kwenyan Professional Health Services, LLC | Clinic/Center | 60 Evergreen Pl, Suite 500, East Orange, NJ 07018-2106 | 2010-06-02 |
| 1629221239 | Kwenyan Professional Health Services, LLC | Psychologist | 60 Evergreen Pl, Suite 500, East Orange, NJ 07018-2106 | 2008-10-28 |
| Street Address |
291 PICKFORD AVE |
| City | PHILLIPSBURG |
| State | NJ |
| Zip Code | 08865-1626 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174840334 | Rebecca Marie Matlock | Chiropractor | 291 Pickford Ave, Phillipsburg, NJ 08865 | 2010-04-28 |
| 1720636988 | Kimberly Nicholls | Social Worker | 291 Pickford Ave, Phillipsburg, NJ 08865-1626 | 2019-08-30 |
| 1003392374 | Kwenyan Professional Health Services, LLC | Clinic/Center | 291 Pickford Ave, Phillipsburg, NJ 08865-1626 | 2018-07-19 |
| 1114358637 | Nicole L Zederbaum | Social Worker | 291 Pickford Ave, Phillipsburg, NJ 08865 | 2013-12-09 |
| 1407140684 | Matlock Chiropractic LLC | Chiropractor | 291 Pickford Ave, Phillipsburg, NJ 08865-1626 | 2011-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748920 | Maria S Hannis | Pharmacist | 1300 Route 22, Phillipsburg, NJ 08865 | 2020-10-23 |
| 1720586886 | Mariana Cristina De Martinez | Counselor | 865 Us Hwy 22 E, Phillipsburg, NJ 08865 | 2018-01-24 |
| 1205353448 | Unity for Developmental Disabilities | Case Management | 212 Summit Ave., Phillipsburg, NJ 08865 | 2017-08-28 |
| 1962954602 | Britt Deluca | Counselor | 865 Us Hwy 22, Phillipsburg, NJ 08865 | 2016-10-28 |
| 1235593302 | Angela Nicolosi | Counselor | 114 South 2nd Street, Phillipsburg, NJ 08865 | 2016-04-05 |
| 1952764698 | Future Project | Day Training, Developmentally Disabled Services | 469 South Main St, Phillipsburg, NJ 08865 | 2016-03-31 |
| 1336485333 | Weiss, Humanick Support Services, LLC | Supports Brokerage | 201 Strykers Crossing, Suite 19-187, Lapatacong, NJ 08865 | 2012-12-19 |
| 1831466119 | Laura A Skrzenski | Pharmacist | 1596 Third Ave, Alpha, NJ 08865 | 2011-11-30 |
| 1841571403 | Darlyn Benemerito Bawasanta | Occupational Therapist | 290 Red School Lane, Brakeley Park Center, Lopatcong, NJ 08865 | 2011-09-08 |
| 1720369614 | Erica B Gracia-cedeno | Counselor | 865 Us Highway 22, Phillipsburg, NJ 08865 | 2011-09-06 |
| Find all providers in zip 08865 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| 1588289615 | Camden County Suboxone LLC | Clinic/Center | 8 Somerdale Sq, Somerdale, NJ 08083-1345 | 2020-06-15 |
| 1558905380 | Grace Community Development Center | Clinic/Center | 100 Melville Ln, Willingboro, NJ 08046-2912 | 2019-11-05 |
| 1740822121 | The Empowerment House, Non Profit Inc. | Clinic/Center | 1314 S Clinton Ave, Trenton, NJ 08611-1436 | 2019-10-17 |
| 1265088892 | Absolute Awakenings Treatment Center LLC | Clinic/Center | 3000 Route 10 West, Denville, NJ 07834 | 2019-08-09 |
| 1326607243 | Recovery Zone Solutions, LLC | Clinic/Center | 124 East Main Street, Ste#109, Denville, NJ 07834 | 2019-06-13 |
| 1720644800 | Ars Treatment Centers of New Jersey, PC | Clinic/Center | 4 Murray Grove Ln, Lanoka Harbor, NJ 08734-2837 | 2019-05-14 |
| 1184182230 | Turning Point, Inc. | Clinic/Center | 101 Prospect St Ste 210, Lakewood, NJ 08701-5003 | 2019-03-07 |
| Find all providers with the same taxonomy | ||||
| City | PHILLIPSBURG |
| Zip Code | 08865 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.