Healthcare Provider Details
I. General information
NPI: 1386427748
Provider Name (Legal Business Name): REAL EYES TRUTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/17/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
801 W MAIN ST
HYANNIS MA
02601-3498
US
IV. Provider business mailing address
1309 RACE LN
MARSTONS MILLS MA
02648-1105
US
V. Phone/Fax
- Phone: 508-815-6493
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251S00000X |
| Taxonomy | Community/Behavioral Health Agency |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
RAJA
SINJAB
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: LMHC
Phone: 774-400-0437