=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255079364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW BEGINNINGS THERAPY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2022
-----------------------------------------------------
Last Update Date | 07/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 BROAD ST # 284
-----------------------------------------------------
City | MICHIGAN CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49254-1275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-250-1031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 BROAD ST # 284
-----------------------------------------------------
City | MICHIGAN CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49254-1275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUDITH PATANIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-250-1031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------