Healthcare Provider Details

I. General information

NPI: 1740688001
Provider Name (Legal Business Name): CREATIVE INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 BLOOMFIELD AVE
WINDSOR CT
06095
US

IV. Provider business mailing address

P.O BOX 367
WINDSOR CT
06095
US

V. Phone/Fax

Practice location:
  • Phone: 860-413-9538
  • Fax: 860-838-4241
Mailing address:
  • Phone: 860-413-9538
  • Fax: 860-838-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT LEVINE
Title or Position: EXECUTIVE DIRECTOR/MEMBER
Credential:
Phone: 860-413-9538