Provider Demographics
NPI:1154620607
Name:BERGEN BEHAVIORAL WELLNESS ASSOCIATES, LLC
Entity type:Organization
Organization Name:BERGEN BEHAVIORAL WELLNESS ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MRS
Authorized Official - First Name:RYNA
Authorized Official - Middle Name:COHEN
Authorized Official - Last Name:LUBOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD, LMFT
Authorized Official - Phone:201-848-5578
Mailing Address - Street 1:169 RAMAPO VALLEY RD
Mailing Address - Street 2:SUITE ML 7
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2531
Mailing Address - Country:US
Mailing Address - Phone:201-848-5578
Mailing Address - Fax:201-848-5599
Practice Address - Street 1:169 RAMAPO VALLEY RD
Practice Address - Street 2:SUITE ML 7
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2531
Practice Address - Country:US
Practice Address - Phone:201-848-5578
Practice Address - Fax:201-848-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004518001041C0700X
NJ37F1000075100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ67541Medicare PIN