NPIMap

Organization Active NPI

Wellsprings Counseling Center, LLC

  • Clinical Social Worker
  • Fair Lawn, NJ
National Provider Identifier
1285844050
Registry record updated May 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05191700 Issued in NJ
Legal business name
WELLSPRINGS COUNSELING CENTER, LLC
Practice address
22-08 State RT 208
Suite 16
Fair Lawn, NJ 07410-2609
Phone
(201) 956-6363
Fax
(201) 956-6026
NPI assigned
May 23, 2007
Last updated
May 6, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Pro-Menner, MCSWNPI 1306058631
Title
President
Phone
(201) 956-6363

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 44SC05191700 NJ Primary

Addresses

Primary practice location

22-08 State RT 208
Suite 16
Fair Lawn, NJ 07410-2609

Mailing address

22-08 State RT 208
Suite 16
Fair Lawn, NJ 07410-2609
Phone (201) 956-6363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240320000285 NJ Part B Supplier - Clinic/Group Practice 7618314113 Receives reassigned benefits from 4 practitioners
Practice locations: Fair Lawn, NJ

National Provider Directory

National Provider Directory

Locations

22-08 State Rt 208
Ste 16
Fair Lawn, NJ 07410
Phone (201) 956-6363

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367798400000",
    "number": "1285844050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22-08 STATE RT 208",
            "address_2": "SUITE 16",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074102609",
            "telephone_number": "201-956-6363",
            "fax_number": "201-956-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22-08 STATE RT 208",
            "address_2": "SUITE 16",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074102609",
            "telephone_number": "201-956-6363",
            "fax_number": "201-956-6026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRINGS COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2013-05-06",
        "status": "A",
        "authorized_official_last_name": "PRO-MENNER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-956-6363",
        "authorized_official_credential": "MCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05191700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Lawn, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.