Provider Demographics
NPI:1053746461
Name:ATLANTIC FAMILY WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ATLANTIC FAMILY WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARUSIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-801-4505
Mailing Address - Street 1:267 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-3110
Mailing Address - Country:US
Mailing Address - Phone:732-801-4505
Mailing Address - Fax:732-269-8385
Practice Address - Street 1:222 SERPENTINE DR
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-3227
Practice Address - Country:US
Practice Address - Phone:732-801-4505
Practice Address - Fax:732-269-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00119700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty