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19 Grand Ave # 1 Newark NJ 07106-1223 | |
| (732) 874-0156 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 19 Grand Ave # 1, Newark, New Jersey |
| Authorized Official Name and Position | Nantume Janet Kabanda (SENIOR PASTOR / REVEREND) |
| Authorized Official Contact | 7328740156 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
19 Grand Ave # 1 Newark NJ 07106-1223 Ph: (732) 874-0156 | 19 Grand Ave # 1 Newark NJ 07106-1223 Ph: (732) 874-0156 |
| NPI Number | 1417598418 |
|---|---|
| Provider Enumeration Date | 10/01/2019 |
| Last Update Date | 12/04/2024 |
| Certification Date | 12/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417598418 | NPI | - | NPPES |
| 10012019457229 | Medicaid | NJ | |
| 10012019457229 | Medicaid | MA | |
| NONE | Other | NJ | NONE |
| 1417598418 | Other | NOT YET | |
| 10012019457229 | Medicaid | GA |
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