Provider Demographics
NPI:1083831499
Name:INFINITY EMPOWERMENT SERVICES
Entity type:Organization
Organization Name:INFINITY EMPOWERMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-346-2409
Mailing Address - Street 1:220 E PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1705
Mailing Address - Country:US
Mailing Address - Phone:609-747-9391
Mailing Address - Fax:609-747-9968
Practice Address - Street 1:215 HIGHLAND AVE
Practice Address - Street 2:STE C
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2634
Practice Address - Country:US
Practice Address - Phone:609-346-2409
Practice Address - Fax:609-747-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052635001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0065161Medicaid