Healthcare Provider Details

I. General information

NPI: 1841014057
Provider Name (Legal Business Name): INTEGRATIVE WELLNESS NURSE PRACTITIONER IN PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CARNEGIE CTR STE 150
PRINCETON NJ
08540-6285
US

IV. Provider business mailing address

169 MADISON AVE STE 38577
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 718-790-4511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA MCBRIDE
Title or Position: EXECUTIVE ASSOCIATE
Credential:
Phone: 225-235-4984