Provider Demographics
NPI:1568203016
Name:360 MENTAL HEALING LLC
Entity type:Organization
Organization Name:360 MENTAL HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:VAISHALI
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-809-1694
Mailing Address - Street 1:20 ADINA TER
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9591
Mailing Address - Country:US
Mailing Address - Phone:973-809-1694
Mailing Address - Fax:
Practice Address - Street 1:2001 US HIGHWAY 46 STE 310
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1315
Practice Address - Country:US
Practice Address - Phone:973-809-1694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Single Specialty