| Live Well Psychology Center, Llc | |
|
48 Woodport Rd Suite 22 Sparta NJ 07871 | |
| (973) 726-5200 | |
| Not Available |
| Full Name | Live Well Psychology Center, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 48 Woodport Rd, Sparta, New Jersey |
| Authorized Official Name and Position | Alexandra Miller (CLINICAL DIRECTOR, OWNER) |
| Authorized Official Contact | 9737265200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Well Psychology Center, Llc 48 Woodport Rd Suite 22 Sparta NJ 07871 Ph: (973) 726-5200 | Live Well Psychology Center, Llc 48 Woodport Rd Suite 22 Sparta NJ 07871 Ph: (973) 726-5200 |
| NPI Number | 1902459670 |
|---|---|
| Provider Enumeration Date | 07/22/2019 |
| Last Update Date | 06/04/2021 |
| Certification Date | 06/04/2021 |
| Medicare PECOS PAC ID | 5799187928 |
|---|---|
| Medicare Enrollment ID | O20210712000997 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902459670 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Heidi E Keller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801088356 PECOS PAC ID: 7810177276 Enrollment ID: I20110202000669 |
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