NPIMap

Organization Active NPI

Kwenyan Professional Health Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • East Orange, NJ
National Provider Identifier
1285928457
Registry record updated Jun 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
0261351 Issued in NJ
Legal business name
KWENYAN PROFESSIONAL HEALTH SERVICES, LLC
Practice address
60 Evergreen PL
Suite 500
East Orange, NJ 07018-2106
Phone
(973) 672-6900
Fax
(866) 376-8262
NPI assigned
Jun 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2011

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

Authorized official

Name
Mr. Daniel E Cassell, MA, MPH, LPC, LCADC
Title
President/Ceo
Phone
(973) 672-6900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0261351 NJ Primary

Addresses

Primary practice location

60 Evergreen PL
Suite 500
East Orange, NJ 07018-2106

Mailing address

60 Evergreen PL
Suite 500
East Orange, NJ 07018-2106
Phone (973) 672-6900

Other identifiers 1

IdentifierTypeStateIssuer
0261351MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Kwenyan Professional Health Services LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

60 Evergreen Pl
Ste 500
East Orange, NJ 07018
Phone (973) 672-6900

NPI Registry JSON

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

{
    "created_epoch": "1307318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307318400000",
    "number": "1285928457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 EVERGREEN PL",
            "address_2": "SUITE 500",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070182106",
            "telephone_number": "973-672-6900",
            "fax_number": "866-376-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 EVERGREEN PL",
            "address_2": "SUITE 500",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070182106",
            "telephone_number": "973-672-6900",
            "fax_number": "866-376-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KWENYAN PROFESSIONAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-06",
        "last_updated": "2011-06-06",
        "status": "A",
        "authorized_official_last_name": "CASSELL",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "973-672-6900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, MPH, LPC, LCADC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NJ",
            "license": "0261351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0261351",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Orange, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.