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General NPI Number Information
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NPI Number | 1316436876
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Entity Type | Organization
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Legal Business Name | RISING PHOENIX PSYCHOTHERAPY & CONSULTING
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 27 CONGRESS ST STE 205-14
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City | SALEM
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State | MA
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Zip | 01970-5595
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Country | US
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Telephone | 978-594-0762
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Fax | 844-666-7395
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Provider Business Mailing Address
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Address Line | 27 CONGRESS ST STE 205-14
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City | SALEM
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State | MA
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Zip | 01970-5595
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Country | US
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Telephone | 978-594-0762
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Fax | 844-666-7395
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRISTOPHER R DEIULIO
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Credential | MSW, LICSW
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Telephone | 978-594-0762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 110153
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License Number State | MA
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