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General NPI Number Information
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NPI Number | 1376093880
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Entity Type | Organization
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Legal Business Name | INTERNAL AFFAIRS TREATMENT GROUP
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 198 NORTH AVE E
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City | CRANFORD
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State | NJ
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Zip | 07016-2469
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Country | US
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Telephone | 908-422-5340
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Fax |
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Provider Business Mailing Address
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Address Line | 210 E 2ND AVE
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City | ROSELLE
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State | NJ
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Zip | 07203-1306
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Country | US
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Telephone | 908-422-5340
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Fax |
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | GREGORY INGRAM
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Credential | LCSW
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Telephone | 908-422-5340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05532900
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License Number State | NJ
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