Provider Demographics
NPI:1194447144
Name:ST MICHAEL MENTAL CARE CONSULT LLC
Entity type:Organization
Organization Name:ST MICHAEL MENTAL CARE CONSULT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ENWERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-412-6427
Mailing Address - Street 1:95 GRANT PL
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1441
Mailing Address - Country:US
Mailing Address - Phone:973-304-5180
Mailing Address - Fax:973-399-3786
Practice Address - Street 1:90 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1050
Practice Address - Country:US
Practice Address - Phone:973-304-5180
Practice Address - Fax:973-399-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty