Provider Demographics
NPI:1841049707
Name:INNOVATIVE PSYCHIATRY LLC
Entity type:Organization
Organization Name:INNOVATIVE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LAVANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-713-6280
Mailing Address - Street 1:157 TENNYSON DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3033
Mailing Address - Country:US
Mailing Address - Phone:732-713-6280
Mailing Address - Fax:866-892-0650
Practice Address - Street 1:157 TENNYSON DR
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3033
Practice Address - Country:US
Practice Address - Phone:732-713-6280
Practice Address - Fax:866-892-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)