Provider Demographics
NPI:1124869797
Name:INNER LIGHT MENTAL HEALTH AND ADDICTION SERVICES L.L.C
Entity type:Organization
Organization Name:INNER LIGHT MENTAL HEALTH AND ADDICTION SERVICES L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOBAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:862-218-2616
Mailing Address - Street 1:1767 MORRIS AVE STE 303B
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3511
Mailing Address - Country:US
Mailing Address - Phone:862-218-2616
Mailing Address - Fax:
Practice Address - Street 1:1767 MORRIS AVE STE 303B
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3511
Practice Address - Country:US
Practice Address - Phone:862-218-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty