Healthcare Provider Details

I. General information

NPI: 1093048787
Provider Name (Legal Business Name): INTEGRATIVE THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 HOLMES ST
QUINCY MA
02171-2433
US

IV. Provider business mailing address

97 HOLMES ST
QUINCY MA
02171-2433
US

V. Phone/Fax

Practice location:
  • Phone: 617-770-1170
  • Fax: 617-770-1174
Mailing address:
  • Phone: 617-770-1170
  • Fax: 617-770-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1027200
License Number StateMA

VIII. Authorized Official

Name: MS. SUSAN SHERRAD BARTON
Title or Position: OWNER
Credential: LICSW
Phone: 617-770-1170