Provider Demographics
NPI:1417760265
Name:WELLNESS AT BARNEGAT BAY LLC
Entity type:Organization
Organization Name:WELLNESS AT BARNEGAT BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:609-713-6761
Mailing Address - Street 1:364 N MAIN ST STE 10C
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3188
Mailing Address - Country:US
Mailing Address - Phone:609-713-6761
Mailing Address - Fax:
Practice Address - Street 1:364 N MAIN ST STE 10C
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3188
Practice Address - Country:US
Practice Address - Phone:609-713-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health