Provider Demographics
NPI:1588114417
Name:INTERNATIONAL CENTER FOR OPTIMAL LIVING
Entity type:Organization
Organization Name:INTERNATIONAL CENTER FOR OPTIMAL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-779-1653
Mailing Address - Street 1:415 LASKO LN
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2331
Mailing Address - Country:US
Mailing Address - Phone:201-779-1653
Mailing Address - Fax:
Practice Address - Street 1:415 LASKO LN
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-2331
Practice Address - Country:US
Practice Address - Phone:201-779-1653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05646800251S00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health