Provider Demographics
NPI:1376323535
Name:INTEGRATIVE JOURNEY MODERN PSYCHOTHERAPY CO
Entity Type:Organization
Organization Name:INTEGRATIVE JOURNEY MODERN PSYCHOTHERAPY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUTERNICK-GERAK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC, ACS
Authorized Official - Phone:718-431-5641
Mailing Address - Street 1:79 MORNING DEW CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3177
Practice Address - Country:US
Practice Address - Phone:609-759-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty