Provider Demographics
| NPI: | 1003955824 |
|---|---|
| Name: | INHEALTH PA |
| Entity type: | Organization |
| Organization Name: | INHEALTH PA |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRACTICE ADMINISTRATOR |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | KATHLEEN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | NIELSEN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | APRN BC |
| Authorized Official - Phone: | 973-579-6700 |
| Mailing Address - Street 1: | 15 STATE ROUTE 15 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LAFAYETTE |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 07848-2007 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 973-579-6700 |
| Mailing Address - Fax: | 973-579-6830 |
| Practice Address - Street 1: | 15 STATE ROUTE 15 |
| Practice Address - Street 2: | |
| Practice Address - City: | LAFAYETTE |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 07848-2007 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 973-579-6700 |
| Practice Address - Fax: | 973-579-6830 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | INHEALTH PA |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-02-06 |
| Last Update Date: | 2010-08-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
| No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
| No | 364SP0813X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Geropsychiatric | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NJ | 6003401 | Medicaid | |
| NJ | 6003401 | Medicaid |
