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General NPI Number Information
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NPI Number | 1164248399
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Entity Type | Organization
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Legal Business Name | INNER OASIS PSYCHOTHERAPY SERVICES LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 6302 POLK ST
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City | WEST NEW YORK
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State | NJ
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Zip | 07093
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Country | US
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Telephone | 862-397-1078
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Fax |
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Provider Business Mailing Address
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Address Line | 1631 DEL PRADO BLVD S STE 300
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City | CAPE CORAL
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State | FL
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Zip | 33990-6740
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | LUISA DOMNGUEZ
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Credential |
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Telephone | 862-397-1078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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