Healthcare Provider Details

I. General information

NPI: 1083831499
Provider Name (Legal Business Name): INFINITY EMPOWERMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HIGHLAND AVE STE C
HADDON TOWNSHIP NJ
08108-2634
US

IV. Provider business mailing address

220 E PEARL ST
BURLINGTON NJ
08016-1705
US

V. Phone/Fax

Practice location:
  • Phone: 609-346-2409
  • Fax: 609-747-9968
Mailing address:
  • Phone: 609-747-9391
  • Fax: 609-747-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05263500
License Number StateNJ

VIII. Authorized Official

Name: ROBIN C WILEY
Title or Position: CEO
Credential: LCSW
Phone: 609-346-2409