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Organization

KWENYAN PROFESSIONAL HEALTH SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DANIEL CASSELL MA, MPH, LPC, LCADC, (PRESIDENT/CEO)
(973) 672-6900
Entity
Organization

Contact information

Practice address
60 EVERGREEN PL, SUITE 500, EAST ORANGE, NJ 07018-2106
(973) 672-6901
(866) 376-8262
Mailing address
60 EVERGREEN PL, SUITE 500, EAST ORANGE, NJ 07018-2106
(973) 672-6901
(866) 376-8262

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
2000479-10
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0226220
NJ
Enumeration date
06/02/2010
Last updated
06/02/2011
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