Organization
INNOVATIVE IDEAS LLC
Active
Organization
INNOVATIVE IDEAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAMALATHARA SRIKANTH M.A.T, BCBA (CLINICAL DIRECTOR)
(609) 721-2227
Entity
Organization
Contact information
Practice address
12 VAN GOGH DR, EAST WINDSOR, NJ 08520-2999
(609) 721-2227
Mailing address
12 VAN GOGH DR, EAST WINDSOR, NJ 08520-2999
(609) 721-2227
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1107089
NJ
Other
Enumeration date
07/26/2015
Last updated
07/26/2015
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