Provider Demographics
NPI:1942349402
Name:PERSONAL INTERNATIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:PERSONAL INTERNATIONAL SERVICES, INC.
Other - Org Name:CENTER FOR WELLNESS AND CREATIVE LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-764-9001
Mailing Address - Street 1:PO BOX 1033
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07422-4033
Mailing Address - Country:US
Mailing Address - Phone:973-764-9001
Mailing Address - Fax:973-764-9005
Practice Address - Street 1:651 CANISTEAR RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07422-2088
Practice Address - Country:US
Practice Address - Phone:973-764-9001
Practice Address - Fax:973-764-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC142231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty