Organization
COMPREHENSIVE PSYCHOLOGICAL AND WELLNESS CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA MARIE GRANATO PSY.D (PHYSICIAN)
(609) 693-4343
Entity
Organization
Contact information
Practice address
424 S MAIN ST, UNIT F, FORKED RIVER, NJ 08731-4641
(609) 693-4343
Mailing address
424 S MAIN ST, UNIT F, FORKED RIVER, NJ 08731-4641
(609) 693-4343
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
35SI00429000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2831657000
AMERIHEALTH GROUP NUMBER
NJ
Enumeration date
05/23/2007
Last updated
03/22/2010
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