Provider Demographics
NPI:1104456490
Name:INSIGHT BASED CHANGE, LLC
Entity type:Organization
Organization Name:INSIGHT BASED CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKSSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN CS
Authorized Official - Phone:215-313-7278
Mailing Address - Street 1:221 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5247
Mailing Address - Country:US
Mailing Address - Phone:215-313-7278
Mailing Address - Fax:
Practice Address - Street 1:220 FARM LN
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4714
Practice Address - Country:US
Practice Address - Phone:215-313-7278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-25
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service