Mind Body Recovery Center, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

44SCO5258800 Issued in NJ

Legal business name

MIND BODY RECOVERY CENTER, LLC

Practice address

12 N State RT 17
Suite 313
Paramus, NJ 07652-2644

Phone

(201) 543-3935

Fax

(201) 226-1141

NPI assigned

Jul 15, 2011

Last updated

Oct 22, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rebecca Henriquez, LCSWNPI 1881861698

Title

President

Phone

(201) 543-3935

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

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.

• Rebecca Henriquez, LCSW

  • Clinical Social Worker
  • Union Beach, NJ
  • NPI 1881861698
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445472000000",
    "number": "1699063362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 N STATE RT 17",
            "address_2": "SUITE 313",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076522644",
            "telephone_number": "201-543-3935",
            "fax_number": "201-226-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 N STATE RT 17",
            "address_2": "SUITE 313",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076522644",
            "telephone_number": "201-543-3935",
            "fax_number": "201-226-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY RECOVERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-15",
        "last_updated": "2015-10-22",
        "status": "A",
        "authorized_official_last_name": "HENRIQUEZ",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-543-3935",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NJ",
            "license": "44SCO5258800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Miller Jr., MD, JD
• Nastasia Amanda Miller
• Tari Miller, M.A.
• Mim Medical PC
• Esjona Mimini, AGNP
• Mino MD LLC
• Danice Miranda
• Panagiota Mish
• Michelle A. Mitchell, LSW
• Suneet Mittal, M.D.

• Community/Behavioral Health Agency in Paramus, NJ
• Providers in Paramus, NJ by specialty
• Community/Behavioral Health Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; 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.