Healthcare Provider Details

I. General information

NPI: 1962316893
Provider Name (Legal Business Name): REALCHANGE ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S WEST ST APT 505
MOUNT VERNON NY
10550-2132
US

IV. Provider business mailing address

22 S WEST ST APT 505
MOUNT VERNON NY
10550-2132
US

V. Phone/Fax

Practice location:
  • Phone: 914-540-4044
  • Fax:
Mailing address:
  • Phone: 914-540-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROXANNE HOLMES
Title or Position: OWNER
Credential: LMFT
Phone: 914-540-4044