Healthcare Provider Details

I. General information

NPI: 1457112070
Provider Name (Legal Business Name): ZOOM OUT THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SHOVE ST # 2
FALL RIVER MA
02724-2046
US

IV. Provider business mailing address

255 SHOVE ST # 2
FALL RIVER MA
02724-2046
US

V. Phone/Fax

Practice location:
  • Phone: 401-269-8368
  • Fax:
Mailing address:
  • Phone: 401-269-8368
  • 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: DR. RICHELENE CESAR
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 401-269-8368