Healthcare Provider Details

I. General information

NPI: 1407598345
Provider Name (Legal Business Name): INTEGRATIVE TRANSFORMATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GLOVER RD
MILLBURY MA
01527-1404
US

IV. Provider business mailing address

6 GLOVER RD
MILLBURY MA
01527-1404
US

V. Phone/Fax

Practice location:
  • Phone: 508-216-0237
  • Fax: 508-519-0417
Mailing address:
  • Phone: 508-216-0237
  • Fax: 508-519-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARA H GOULD
Title or Position: OWNER
Credential: LICSW
Phone: 508-769-5830