Healthcare Provider Details

I. General information

NPI: 1104635192
Provider Name (Legal Business Name): CREO THERAPY STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JUNIPER ROAD
SANTA FE NM
87556
US

IV. Provider business mailing address

5 JUNIPER ROAD
SANTA FE NM
87556
US

V. Phone/Fax

Practice location:
  • Phone: 650-380-9547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: ARIELLE ROTHENBERG
Title or Position: OWNER
Credential: LPAT
Phone: 650-380-9547