Provider Demographics
NPI:1962756031
Name:INSTITUTE FOR LEARNING & BEHAVIORAL SCIENCES LLC
Entity type:Organization
Organization Name:INSTITUTE FOR LEARNING & BEHAVIORAL SCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:C
Authorized Official - Last Name:STANKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-439-5908
Mailing Address - Street 1:1512 E CARACAS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1184
Mailing Address - Country:US
Mailing Address - Phone:717-439-5908
Mailing Address - Fax:
Practice Address - Street 1:1512 E CARACAS AVE STE 300
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1184
Practice Address - Country:US
Practice Address - Phone:717-439-5908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QM0850X
NJ35SI00488600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health