Provider Demographics
NPI:1912458167
Name:BLUE MOOD SOLUTIONS, LLC
Entity Type:Organization
Organization Name:BLUE MOOD SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:718-496-1149
Mailing Address - Street 1:538 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3306
Mailing Address - Country:US
Mailing Address - Phone:718-496-1149
Mailing Address - Fax:
Practice Address - Street 1:180 TICES LN
Practice Address - Street 2:BLDG A, STE 201C
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1345
Practice Address - Country:US
Practice Address - Phone:718-496-1149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health