| Live Wonderfully Therapy, Llc | |
|
48 Melbourne St Edison NJ 08817-5431 | |
| (732) 305-0076 | |
| Not Available |
| Full Name | Live Wonderfully Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 48 Melbourne St, Edison, New Jersey |
| Authorized Official Name and Position | Raelyn Sprenkle (OWNER) |
| Authorized Official Contact | 7323050076 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Wonderfully Therapy, Llc 48 Melbourne St Edison NJ 08817-5431 Ph: (732) 305-0076 | Live Wonderfully Therapy, Llc 48 Melbourne St Edison NJ 08817-5431 Ph: (732) 305-0076 |
| NPI Number | 1659143873 |
|---|---|
| Provider Enumeration Date | 10/23/2023 |
| Last Update Date | 10/23/2023 |
| Certification Date | 10/23/2023 |
| Medicare PECOS PAC ID | 1557705217 |
|---|---|
| Medicare Enrollment ID | O20240221001558 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659143873 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Raelyn M Sprenkle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043592447 PECOS PAC ID: 7911260435 Enrollment ID: I20180416002626 |
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