Provider Demographics
NPI:1114726916
Name:ALCHEMICAL KINNECTIONS INTEGRATIVE THERAPY
Entity type:Organization
Organization Name:ALCHEMICAL KINNECTIONS INTEGRATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:SURRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCOME
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:929-352-2098
Mailing Address - Street 1:111 TOWN SQUARE PL STE 1238
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1810
Mailing Address - Country:US
Mailing Address - Phone:929-352-2098
Mailing Address - Fax:
Practice Address - Street 1:109 FRANK E RODGERS BLVD S
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2085
Practice Address - Country:US
Practice Address - Phone:929-352-2098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty