Healthcare Provider Details

I. General information

NPI: 1184472763
Provider Name (Legal Business Name): ENODIA VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 GREENFIELD RD
DEERFIELD MA
01342-9714
US

IV. Provider business mailing address

408 GREENFIELD RD
DEERFIELD MA
01342-9714
US

V. Phone/Fax

Practice location:
  • Phone: 413-248-8823
  • Fax:
Mailing address:
  • Phone: 413-248-8823
  • 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: AMBER MEGAN HOLBROOK
Title or Position: EMPLOYEE
Credential: PHD, LICSW
Phone: 413-248-8823