Healthcare Provider Details

I. General information

NPI: 1972834026
Provider Name (Legal Business Name): ALCHEMY ACUPUNCTURE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 26TH ST W
BRADENTON FL
34207-3516
US

IV. Provider business mailing address

7711 DESOTO MEMORIAL HWY
BRADENTON FL
34209-9789
US

V. Phone/Fax

Practice location:
  • Phone: 941-779-7443
  • Fax:
Mailing address:
  • Phone: 941-779-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1030424
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2683
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 9349
License Number StateFL

VIII. Authorized Official

Name: LISA M GROSSMAN
Title or Position: OWNER
Credential: DOM, AP, LCSW
Phone: 941-779-7443