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Organization

LIVE WELL CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LUIS LUNA M.D. (MEDICAL DIRECTOR)
(201) 934-9467
Entity
Organization

Contact information

Practice address
8 BIRCHWOOD CT, UPPER SADDLE RIVER, NJ 07458-1905
(201) 934-9467
Mailing address
8 BIRCHWOOD CT, UPPER SADDLE RIVER, NJ 07458-1905

Taxonomy

Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
35SI00415000
NJ
103TC1900X
Counseling Psychologist
35SI00415000
NJ
207RA0401X
Addiction Medicine (Internal Medicine) Physician
25MA07806100
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0140210
NJ
Enumeration date
07/09/2010
Last updated
07/09/2010
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