Healthcare Provider Details

I. General information

NPI: 1801462197
Provider Name (Legal Business Name): TOTAL METAMORPHOSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 11/29/2022
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 FOREST ST SUITE 270 #573
MARLBOROUGH MA
01752
US

IV. Provider business mailing address

67 FOREST ST SUITE 270 #573
MARLBOROUGH MA
01752
US

V. Phone/Fax

Practice location:
  • Phone: 978-795-4995
  • Fax:
Mailing address:
  • Phone: 978-482-7189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: YAKIRA ALUSMA
Title or Position: CO-OWNER
Credential:
Phone: 978-795-4995