Provider Demographics
NPI:1770845414
Name:THERAPEUTIC IMPRINTS
Entity Type:Organization
Organization Name:THERAPEUTIC IMPRINTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERERIA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:718-409-6977
Mailing Address - Street 1:1120 MORRIS PARK AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1400
Mailing Address - Country:US
Mailing Address - Phone:718-409-6977
Mailing Address - Fax:718-409-6946
Practice Address - Street 1:1120 MORRIS PARK AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1400
Practice Address - Country:US
Practice Address - Phone:718-409-6977
Practice Address - Fax:718-409-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management