=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134622277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATIVE CONNECTIONS THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2018
-----------------------------------------------------
Last Update Date | 10/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7047 GERMANTOWN AVE STE 202
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19119-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-422-4858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7047 GERMANTOWN AVE STE 202
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19119-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-422-4858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST/OWNER
-----------------------------------------------------
Name | ELIZABETH SACCENTI
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 267-422-4858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PC010293
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------