Stanford Angels Clear Mind and Wellness LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

STANFORD ANGELS CLEAR MIND AND WELLNESS LLC

Practice address

1600 Saint Georges Ave Ste 301
Rahway, NJ 07065-2713

Phone

(848) 336-0965

Fax

(908) 248-0804

NPI assigned

May 6, 2024

Last updated

Aug 20, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

STANFORD ANGELS LLCAs reported in NPPES

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

Authorized official

Name

Ms. Catina Burkett, LCSW

Title

Social Work Clinical Supervisor

Phone

(201) 814-2759

Specialties & licenses 2

Addresses

Other names 1

• Stanford Angels LLC Other name

Part of

Stanford Angels LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Stanford Angels LLC

  • Home Health Agency
  • Edison, NJ
  • NPI 1134724883
  NPPES parent name

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

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1770330730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SAINT GEORGES AVE STE 301",
            "city": "RAHWAY",
            "state": "NJ",
            "postal_code": "070652713",
            "telephone_number": "848-336-0965",
            "fax_number": "908-248-0804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SAINT GEORGES AVE STE 301",
            "city": "RAHWAY",
            "state": "NJ",
            "postal_code": "070652713",
            "telephone_number": "848-336-0965",
            "fax_number": "908-248-0804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANFORD ANGELS CLEAR MIND AND WELLNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STANFORD ANGELS LLC",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "BURKETT",
        "authorized_official_first_name": "CATINA",
        "authorized_official_title_or_position": "SOCIAL WORK CLINICAL SUPERVISOR",
        "authorized_official_telephone_number": "201-814-2759",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stanford Angels LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Stanford Angels LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Raeesa Ashfaq Soomar
• Speech & Swallow Matters LLC
• Anne-Marie Spricigo, LCSW
• St George Behavioral Care, Inc
• Jillian Stabert, LPC
• Stations Cab
• Alyssa Steele
• Diane C. Strickland, RN, APN
• Kathleen Sweeney, LCSW
• Susan A Szurko

• Adult Mental Health Clinic/Center in Rahway, NJ
• Providers in Rahway, NJ by specialty
• Adult Mental Health Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.