Illuminating Possibilities Therapeutic Services

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ILLUMINATING POSSIBILITIES THERAPEUTIC SERVICES

Practice address

983 Summit Ave
Jersey City, NJ 07307-3601

Phone

(201) 284-9136

NPI assigned

Jun 6, 2019

Last updated

Jun 11, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Larissa Fedak, EDD SLP BCBA-D LBA

Title

Founder/Chief Clinical Director

Phone

(201) 284-9136

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1538728209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 DUNELLEN AVE",
            "city": "DUNELLEN",
            "state": "NJ",
            "postal_code": "088121236",
            "telephone_number": "551-226-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "983 SUMMIT AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073073601",
            "telephone_number": "201-284-9136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATING POSSIBILITIES THERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "FEDAK",
        "authorized_official_first_name": "LARISSA",
        "authorized_official_title_or_position": "FOUNDER/CHIEF CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "201-284-9136",
        "authorized_official_credential": "EDD SLP BCBA-D LBA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "1235376997",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christena Ibrahim, LPC, NCC
• Mary Ibrahim, MD
• Sherif Ibrahim
• Janbeck Idabole, DO
• Alexis Iglesias, LAC, NCC
• James Imm
• Immediate Care P.C.
• Immersed Therapies
• Imperial Shoe Store Co Inc (Imperial Shoes)
• In-Balance Psychotherapy

• Clinic/Center in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.