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General NPI Number Information
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NPI Number | 1790498954
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Entity Type | Organization
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Legal Business Name | INNERWEAVE PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 115 W 30TH ST RM 709
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City | NEW YORK
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State | NY
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Zip | 10001-4068
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Country | US
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Telephone | 347-994-9616
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Fax |
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Provider Business Mailing Address
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Address Line | 228 PARK AVE S
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City | NEW YORK
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State | NY
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Zip | 10003-1502
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Country | US
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Telephone | 347-994-9616
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Fax |
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Authorized Official
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Title or Position | FOUNDER; PSYCHOLOGIST
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Name | DR. JUSTINA DILLON
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Credential | PH.D.
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Telephone | 908-331-3563
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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