Healthcare Provider Details

I. General information

NPI: 1952265274
Provider Name (Legal Business Name): INNERCLARITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1005 SCOTT TOWN CTR # 1004
BLOOMSBURG PA
17815-2356
US

IV. Provider business mailing address

1005 SCOTT TOWN CTR # 1004
BLOOMSBURG PA
17815-2356
US

V. Phone/Fax

Practice location:
  • Phone: 570-204-5110
  • Fax: 272-249-2494
Mailing address:
  • Phone: 570-204-5110
  • Fax: 272-249-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS IACOVONI
Title or Position: OWNER
Credential:
Phone: 570-204-5110