Organization
BRIGHTPATH SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KEZIA WALLERSON (OWNER)
(315) 415-7148
Entity
Organization
Contact information
Practice address
25 HIGH ST APT C1, MONTCLAIR, NJ 07042-2452
(315) 415-7148
Mailing address
25 HIGH ST APT C1, MONTCLAIR, NJ 07042-2452
(315) 415-7148
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/27/2026
Last updated
02/27/2026
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