Healthcare Provider Details

I. General information

NPI: 1497675607
Provider Name (Legal Business Name): BLANK CANVAS THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CUSTER ST
LAWRENCE MA
01841-1906
US

IV. Provider business mailing address

73 TURNPIKE ST STE 1139
NORTH ANDOVER MA
01845-5045
US

V. Phone/Fax

Practice location:
  • Phone: 978-482-7189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: YAKIRA NUNEZ
Title or Position: OWNER
Credential: LMHC
Phone: 978-482-7189