Provider Demographics
NPI:1861152530
Name:INNOVATIVE MENTAL HEALTH THERAPIES
Entity type:Organization
Organization Name:INNOVATIVE MENTAL HEALTH THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:732-841-9191
Mailing Address - Street 1:5406 WOODLAND AVE
Mailing Address - Street 2:SUITE 2305
Mailing Address - City:POCONO PINES
Mailing Address - State:PA
Mailing Address - Zip Code:18350
Mailing Address - Country:US
Mailing Address - Phone:732-841-9191
Mailing Address - Fax:
Practice Address - Street 1:330 MILLTOWN RD STE 22
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2267
Practice Address - Country:US
Practice Address - Phone:908-992-9227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty