Provider Demographics
NPI:1487492385
Name:WELLNESS DIALOGUES LCSW, PLLC
Entity type:Organization
Organization Name:WELLNESS DIALOGUES LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAURIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-521-1217
Mailing Address - Street 1:447 BROADWAY
Mailing Address - Street 2:FL 2, #1410
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 WATCHUNG AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1710
Practice Address - Country:US
Practice Address - Phone:856-521-1217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty