Healthcare Provider Details

I. General information

NPI: 1285188102
Provider Name (Legal Business Name): EMBRACING THE CREATIVE CHILD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DEER PARK DR
EAST LONGMEADOW MA
01028-3198
US

IV. Provider business mailing address

55 DEER PARK DR
EAST LONGMEADOW MA
01028-3198
US

V. Phone/Fax

Practice location:
  • Phone: 413-525-1500
  • Fax:
Mailing address:
  • Phone: 413-801-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SARAH GALE
Title or Position: OWNER
Credential:
Phone: 413-801-4380