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General NPI Number Information
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NPI Number | 1164007050
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Entity Type | Organization
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Legal Business Name | BRAIN BODY INTEGRATIVE THERAPY, LLC
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 924 COLONIAL AVE. BLDG. N STE. 308
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City | YORK
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State | PA
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Zip | 17403
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Country | US
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Telephone | 701-566-2453
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Fax | 717-461-2973
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Provider Business Mailing Address
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Address Line | 924 COLONIAL AVE. BLDG N SUITE 308
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City | YORK
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State | PA
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Zip | 17403
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Country | US
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Telephone | 717-220-8660
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Fax | 717-461-2973
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Authorized Official
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Title or Position | OWNER/ CLINICAL DIRECTOR
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Name | JENNIFER SHATZKIN
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Credential | LCSW
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Telephone | 717-220-8660
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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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