Healthcare Provider Details

I. General information

NPI: 1174210991
Provider Name (Legal Business Name): THERAPY UNLEASHED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PRESCOTT AVE
CHELSEA MA
02150-2113
US

IV. Provider business mailing address

74 PRESCOTT AVE
CHELSEA MA
02150-2113
US

V. Phone/Fax

Practice location:
  • Phone: 845-282-2746
  • Fax:
Mailing address:
  • Phone: 845-282-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA STEPHENS-MALLOY
Title or Position: SOCIAL WORKER/OWNER
Credential: LICSW
Phone: 845-282-2746