Provider Demographics
NPI:1902103518
Name:WELLNESS U PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WELLNESS U PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARIDES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-638-5819
Mailing Address - Street 1:172 FRANKLIN AVE
Mailing Address - Street 2:SUITE 4 A
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3250
Mailing Address - Country:US
Mailing Address - Phone:201-638-5819
Mailing Address - Fax:866-836-4161
Practice Address - Street 1:172 FRANKLIN AVE
Practice Address - Street 2:SUITE 4 A
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3250
Practice Address - Country:US
Practice Address - Phone:201-638-5819
Practice Address - Fax:866-836-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44 SC0067340261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)