Provider Demographics
NPI:1134524689
Name:INTERLUDE MUSIC THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:INTERLUDE MUSIC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MUSIC THERAPIST, DOULA
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MMT, MT-BC, CD
Authorized Official - Phone:504-434-2229
Mailing Address - Street 1:PO BOX 11994
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-0294
Mailing Address - Country:US
Mailing Address - Phone:504-434-2229
Mailing Address - Fax:
Practice Address - Street 1:1721 W RITNER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4333
Practice Address - Country:US
Practice Address - Phone:504-434-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA07394225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty