Provider Demographics
NPI:1619241650
Name:INTRAPERSONAL WELLNESS
Entity Type:Organization
Organization Name:INTRAPERSONAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:COLUCCI
Authorized Official - Last Name:LEBBAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-350-3457
Mailing Address - Street 1:112 ALEXANDRIA WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2763
Mailing Address - Country:US
Mailing Address - Phone:908-350-3457
Mailing Address - Fax:
Practice Address - Street 1:73 W END AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1828
Practice Address - Country:US
Practice Address - Phone:908-963-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053647001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ231067Medicare UPIN