Healthcare Provider Details

I. General information

NPI: 1134524689
Provider Name (Legal Business Name): INTERLUDE MUSIC THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 W RITNER ST
PHILADELPHIA PA
19145-4333
US

IV. Provider business mailing address

PO BOX 11994
PHILADELPHIA PA
19145-0294
US

V. Phone/Fax

Practice location:
  • Phone: 504-434-2229
  • Fax:
Mailing address:
  • Phone: 504-434-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number07394
License Number StatePA

VIII. Authorized Official

Name: HEIDI LENGEL
Title or Position: MUSIC THERAPIST, DOULA
Credential: MMT, MT-BC, CD
Phone: 504-434-2229