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General NPI Number Information
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NPI Number | 1982760112
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR CHANGE
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 460 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3582
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Country | US
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Telephone | 973-734-0780
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Fax |
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Provider Business Mailing Address
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Address Line | 460 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3582
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Country | US
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Telephone | 973-734-0780
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DAVID SZMAK
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Credential | PSY.D.
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Telephone | 973-734-0780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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