Organization
CREATE CHANGE WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYRENA M DUSSARD MSW, LSW (CLINICAL DIRECTOR)
(973) 567-5941
Entity
Organization
Contact information
Practice address
50 E 37TH ST, PATERSON, NJ 07514-1212
(973) 567-5941
Mailing address
50 E 37TH ST, PATERSON, NJ 07514-1212
(973) 567-5941
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/13/2019
Last updated
05/13/2019
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