Provider Demographics
NPI:1972901833
Name:SERENITY WITHIN,INC
Entity type:Organization
Organization Name:SERENITY WITHIN,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPISTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOBERENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-945-2013
Mailing Address - Street 1:85 BALD CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-2801
Mailing Address - Country:US
Mailing Address - Phone:215-945-2013
Mailing Address - Fax:
Practice Address - Street 1:85 BALD CYPRESS LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-2801
Practice Address - Country:US
Practice Address - Phone:215-945-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG005282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA225700000XOtherMASSAGE THERAPISTS