Organization
ILLUMINATING POSSIBILITIES THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISSA FEDAK EDD SLP BCBA-D LBA (FOUNDER/CHIEF CLINICAL DIRECTOR)
(201) 284-9136
Entity
Organization
Contact information
Practice address
983 SUMMIT AVE, JERSEY CITY, NJ 07307-3601
(201) 284-9136
Mailing address
434 DUNELLEN AVE, DUNELLEN, NJ 08812-1236
(551) 226-1112
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235376997
PRIVATE INSURANCE
NJ
Enumeration date
06/06/2019
Last updated
06/11/2019
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