MEDICARE: HEALTHY OUTLOOK THERAPEUTIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639934946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY OUTLOOK THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	18 COOK RD
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-4802
Country	:	US
Telephone Number	:	443-206-5515
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 COOK RD
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-4802
Country	:	US
Telephone Number	:	443-206-5515
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MALISA SHREVE
Credential	:
Telephone Number	:	443-206-5515

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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