# CHAVIV TRT & WELLNESS CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619855442
- **Authorized official:** VIVIAN OWUSU-MENSAH DNP, PMHNP, APN (NURSE PRACTITIONER)
- **Authorized official phone:** (973) 902-8484

## Contact information

- **Practice address:** 750 ROUTE 73 S STE 205, MARLTON, NJ 08053-4133
- **Practice address phone:** (609) 507-1939
- **Mailing address:** 44 BERNARD DR, EWING, NJ 08628-2301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QH0100X | Health Service Clinic/Center | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |
| 364SP0808X | Psychiatric/Mental Health Clinical Nurse Specialist | — | NULL | — |
| 364SP0808X | Psychiatric/Mental Health Clinical Nurse Specialist | — | — | — |

## Other

- **Enumeration date:** 08/21/2025
- **Last updated:** 08/21/2026