| Achieving Nirvana Llc | |
|
2402 Browning Rd Pennsauken NJ 08110-1917 | |
| (267) 630-4688 | |
| Not Available |
| Full Name | Achieving Nirvana Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2402 Browning Rd, Pennsauken, New Jersey |
| Authorized Official Name and Position | Amber Pham (THERAPIST) |
| Authorized Official Contact | 2676304688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Achieving Nirvana Llc 2402 Browning Rd Pennsauken NJ 08110-1917 Ph: () - | Achieving Nirvana Llc 2402 Browning Rd Pennsauken NJ 08110-1917 Ph: (267) 630-4688 |
| NPI Number | 1578173282 |
|---|---|
| Provider Enumeration Date | 08/06/2020 |
| Last Update Date | 08/06/2020 |
| Certification Date | 08/06/2020 |
| Medicare PECOS PAC ID | 9436575040 |
|---|---|
| Medicare Enrollment ID | O20200813001164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578173282 | NPI | - | NPPES |
| 0450498715 | Other | NJ | CERTIFICATION OF FORMATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amber Pham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073138681 PECOS PAC ID: 6002239902 Enrollment ID: I20200710002075 |
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