Provider Demographics
NPI:1912247552
Name:EVERMORE WELLNESS, LLC
Entity type:Organization
Organization Name:EVERMORE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORCOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-672-6564
Mailing Address - Street 1:24 N 3RD AVE
Mailing Address - Street 2:SUITE 203E
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2429
Mailing Address - Country:US
Mailing Address - Phone:732-672-6564
Mailing Address - Fax:732-640-2722
Practice Address - Street 1:24 N 3RD AVE
Practice Address - Street 2:SUITE 203E
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2429
Practice Address - Country:US
Practice Address - Phone:732-672-6564
Practice Address - Fax:732-640-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00501200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306105846OtherPERSONAL NPI