Provider Demographics
NPI:1720636723
Name:INNER IMAGINATION, LLC
Entity Type:Organization
Organization Name:INNER IMAGINATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-705-1082
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-0959
Mailing Address - Country:US
Mailing Address - Phone:732-705-1082
Mailing Address - Fax:
Practice Address - Street 1:482 BRICK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6077
Practice Address - Country:US
Practice Address - Phone:732-705-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)