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General NPI Number Information
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NPI Number | 1023686946
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Entity Type | Organization
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Legal Business Name | GREENTOPIA LLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 4 PROMENADE AVE
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City | SACO
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State | ME
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Zip | 04072-2952
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Country | US
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Telephone | 207-205-1943
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Fax |
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Provider Business Mailing Address
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Address Line | 4 PROMENADE AVE
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City | SACO
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State | ME
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Zip | 04072-2952
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Country | US
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Telephone | 207-205-1943
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. CHRISTIAN ALLEN KREUZBERGER
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Credential | LCSW
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Telephone | 207-405-3607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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