NPIMap

Organization Active NPI

Kwenyan Professional Health Services, LLC

  • Professional Counselor
  • East Orange, NJ
National Provider Identifier
1629221239
Registry record updated Jun 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
37PC00330900 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
Oct 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2011

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

Authorized official

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 37PC00330900 NJ Primary
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X 37LC00040000 NJ
Community/Behavioral Health Agency 251S00000X LPC004779 PA
Home Health AideGroup: 193200000X MULTI-SPECIALTY GROUP 374U00000X 26NR13660400 NJ

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
0175366MedicaidNJ

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.

NPI Registry JSON

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306972800000",
    "number": "1629221239",
    "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": "2008-10-28",
        "last_updated": "2011-06-02",
        "status": "A",
        "authorized_official_last_name": "CASSELL",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/PRESIDENT",
        "authorized_official_telephone_number": "973-672-6900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, MPH, LPC, LCADC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00330900",
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00040000",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "LPC004779",
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": "NJ",
            "license": "26NR13660400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0175366",
            "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 2, 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.