MEDICARE: INNERCLARITY 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1952265274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNERCLARITY LLC

Provider Business Mailing Address
First Line	:	1005 SCOTT TOWN CTR # 1004
Second Line	:
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-2356
Country	:	US
Telephone Number	:	570-204-5110
Fax Number	:	272-249-2494

Provider Business Practice Location Address
First Line	:	1005 SCOTT TOWN CTR # 1004
Second Line	:
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-2356
Country	:	US
Telephone Number	:	570-204-5110
Fax Number	:	272-249-2494

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS IACOVONI
Credential	:
Telephone Number	:	570-204-5110

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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Directions to “INNERCLARITY LLC ” Practice Location

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