Healthcare Provider Details

I. General information

NPI: 1336791482
Provider Name (Legal Business Name): SPOTTED RABBIT CREATIVE ARTS THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 12/27/2020
Certification Date: 12/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 MONROE AVE
ROCHESTER NY
14618-3032
US

IV. Provider business mailing address

2376 MONROE AVE
ROCHESTER NY
14618-3032
US

V. Phone/Fax

Practice location:
  • Phone: 585-430-9877
  • Fax: 585-486-5772
Mailing address:
  • Phone: 585-430-9877
  • Fax: 585-200-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH BEREN
Title or Position: DIRECTOR
Credential: LCAT
Phone: 585-430-9877