| Daterra Psychotherapy And Wellness, Inc. | |
|
290 Ferry St Bsmt A2 Newark NJ 07105-3475 | |
| (917) 459-2463 | |
| Not Available |
| Full Name | Daterra Psychotherapy And Wellness, Inc. |
|---|---|
| Speciality | Counselor - Professional |
| Location | 290 Ferry St Bsmt A2, Newark, New Jersey |
| Authorized Official Name and Position | Susana P Gaia (S-CORP OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 9176223749 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Daterra Psychotherapy And Wellness, Inc. 5808 Washington St Apt 305 West New York NJ 07093-1583 Ph: (917) 622-3749 | Daterra Psychotherapy And Wellness, Inc. 290 Ferry St Bsmt A2 Newark NJ 07105-3475 Ph: (917) 459-2463 |
| NPI Number | 1467964734 |
|---|---|
| Provider Enumeration Date | 10/26/2017 |
| Last Update Date | 10/26/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467964734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 007828-1 (New York) | Secondary |
| 101YP2500X | Counselor - Professional | 37PC00598200 (New Jersey) | Primary |
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