MEDICARE: INTHERAPY INSTITUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1235944596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTHERAPY INSTITUTE LLC

Provider Business Mailing Address
First Line	:	80 RIVER ST STE 3E1
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5626
Country	:	US
Telephone Number	:	201-677-5242
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 RIVER ST STE 3E1
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5626
Country	:	US
Telephone Number	:	201-677-5242
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER-DIRECTOR-PSYCHOLOGIST
Name	:	KONSTANTIN LUKIN
Credential	:	PH.D.
Telephone Number	:	201-409-0391

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	03/05/2026

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