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General NPI Number Information
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NPI Number | 1093048787
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE THERAPIES, LLC
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 97 HOLMES ST
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City | QUINCY
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State | MA
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Zip | 02171-2433
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Country | US
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Telephone | 617-770-1170
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Fax | 617-770-1174
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Provider Business Mailing Address
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Address Line | 97 HOLMES ST
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City | QUINCY
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State | MA
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Zip | 02171-2433
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Country | US
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Telephone | 617-770-1170
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Fax | 617-770-1174
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUSAN SHERRAD BARTON
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Credential | LICSW
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Telephone | 617-770-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1027200
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License Number State | MA
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