Provider Demographics
NPI:1265898290
Name:LIVE WELL PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:LIVE WELL PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LABIN BEKELJA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-512-5483
Mailing Address - Street 1:21 JENNINGS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3307
Mailing Address - Country:US
Mailing Address - Phone:609-512-5483
Mailing Address - Fax:609-450-7052
Practice Address - Street 1:21 JENNINGS RD STE 1
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3307
Practice Address - Country:US
Practice Address - Phone:609-512-5483
Practice Address - Fax:609-450-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00564800251S00000X
NJ35S100550500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ469578Medicare UPIN