Provider Demographics
NPI:1700169687
Name:INSTRUMENTAL CHANGE LLC
Entity Type:Organization
Organization Name:INSTRUMENTAL CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-313-4341
Mailing Address - Street 1:210 E MAPLE AVE
Mailing Address - Street 2:D3
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2615
Mailing Address - Country:US
Mailing Address - Phone:609-313-4341
Mailing Address - Fax:
Practice Address - Street 1:210 E MAPLE AVE
Practice Address - Street 2:D3
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2615
Practice Address - Country:US
Practice Address - Phone:609-313-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty