Provider Demographics
NPI:1396912044
Name:INSTITUTE FOR PSYCHOLOGICAL AND SPIRITUAL GROWTH INC
Entity type:Organization
Organization Name:INSTITUTE FOR PSYCHOLOGICAL AND SPIRITUAL GROWTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:DE BONIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW PHD
Authorized Official - Phone:732-739-4098
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:SUITE34
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-739-4098
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:SUITE34
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-739-4098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00022200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640672Medicare PIN