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General NPI Number Information
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NPI Number | 1548159395
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Entity Type | Organization
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Legal Business Name | EASTERN ARTISTS EXPRESSIVE THERAPIES
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Dates
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Enumeration Date | 06/28/2025
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Last Update Date | 06/28/2025
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Provider Practice Location Address
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Address Line | 10416 NW 148TH PL
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City | ALACHUA
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State | FL
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Zip | 32615-5725
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Country | US
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Telephone | 561-617-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 10416 NW 148TH PL
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City | ALACHUA
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State | FL
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Zip | 32615-5725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | TIM COHEN
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Credential |
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Telephone | 914-552-0018
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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