Provider Demographics
NPI:1578345005
Name:INNOVATIVE PSYCHOLOGICAL WELLNESS PLLC
Entity Type:Organization
Organization Name:INNOVATIVE PSYCHOLOGICAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:347-581-4323
Mailing Address - Street 1:220 5TH AVE FL 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-8017
Mailing Address - Country:US
Mailing Address - Phone:347-581-4323
Mailing Address - Fax:
Practice Address - Street 1:220 5TH AVE FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-8017
Practice Address - Country:US
Practice Address - Phone:646-475-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty