Create Change Wellness Center LLC

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

CREATE CHANGE WELLNESS CENTER LLC

Practice address

50 E 37TH St
Paterson, NJ 07514-1212

Phone

(973) 567-5941

NPI assigned

May 13, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Cyrena M Dussard, MSW, LSWNPI 1366927386

Title

Clinical Director

Phone

(973) 567-5941

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cyrena M Dussard, MSW, LSW

  • Social Worker
  • Paterson, NJ
  • NPI 1366927386
  NPD (past) Authorized official

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557705600000",
    "number": "1619533916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 E 37TH ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141212",
            "telephone_number": "973-567-5941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E 37TH ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141212",
            "telephone_number": "973-567-5941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATE CHANGE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-13",
        "last_updated": "2019-05-13",
        "status": "A",
        "authorized_official_last_name": "DUSSARD",
        "authorized_official_first_name": "CYRENA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "973-567-5941",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW, LSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; 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.