MEDICARE: INNER BALANCE PSYCHOLOGY CENTER, 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	103TC0700X	Clinical Psychologist	4889	NJ

General Provider Information

NPI Number	:	1952725905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER BALANCE PSYCHOLOGY CENTER, LLC

Provider Business Mailing Address
First Line	:	525 ROUTE 73 N STE 107
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3422
Country	:	US
Telephone Number	:	609-613-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 ROUTE 73 N STE 107
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3422
Country	:	US
Telephone Number	:	609-613-0110
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DAWN RAFFA
Credential	:	PH.D
Telephone Number	:	609-613-0110

Provider Enumeration Date	:	02/11/2014
Last Update Date	:	04/10/2026

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