Organization
KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Active
Parent organization
KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Other names
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
291 PICKFORD AVE, PHILLIPSBURG, NJ 08865-1626
(908) 777-3744
(908) 777-3746
Mailing address
291 PICKFORD AVE, PHILLIPSBURG, NJ 08865-1626
(908) 777-3744
(908) 777-3746
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
101950304
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101950304
INTENSIVE OUTPATIENT MENTAL HEALTH SERVICES
NJ
Enumeration date
07/19/2018
Last updated
07/19/2018
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