Organization
INNOVATIVE CAREER CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA NELLY LAVERGNE PH.D. (OWNER)
(917) 445-6323
Entity
Organization
Contact information
Practice address
116 W 23RD ST, #206, 5TH FLOOR, NEW YORK, NY 10011-2599
(917) 445-6323
(212) 313-9439
Mailing address
268 EDGEMONT TER, TEANECK, NJ 07666-3404
(917) 445-6323
(212) 313-9439
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
000351-1
NY
103TR0400X
Rehabilitation Psychologist
37RT00288300
NJ
Other
Enumeration date
01/31/2012
Last updated
01/31/2012
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