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Organization
KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Active
Organization
KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Active
Parent organization
KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Authorized official
DR. DR. DANIEL ESTRADA CASSELL, PH.D., MPH PH.D., MPH (PRESIDENT/CEO: ADMINISTRATOR)
(215) 432-3702
Entity
Organization
Contact information
Practice address
200 SOUTH ST, NEW PROVIDENCE, NJ 07974-2151
(908) 516-2338
(866) 376-8262
Mailing address
19 HUTTON AVE, WEST ORANGE, NJ 07052-4803
(609) 284-5822
(866) 376-8262
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101950404
NJ OFFICE OF LICENSING: OUTPATIENT MENTAL HEALTH SERVICES
NJ
Enumeration date
03/18/2019
Last updated
03/18/2019
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