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Organization
INTELLISTARS THERAPY
Active
Organization
INTELLISTARS THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM GREENWALD (DIRECTOR)
(248) 770-3658
Entity
Organization
Contact information
Practice address
275 UPPER RIVERDALE RD STE D, RIVERDALE, GA 30274-2556
(248) 770-3658
Mailing address
13 SHENANDOAH DR, LAKEWOOD, NJ 08701-4979
(248) 770-3658
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0450671179
STATE OF NJ
NJ
Enumeration date
07/01/2021
Last updated
12/10/2025
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