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General NPI Number Information
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NPI Number | 1588202345
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Entity Type | Organization
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Legal Business Name | LIFE TRANSITIONS THERAPY, LLC
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 730 BOSTON POST RD UNIT SUITE26
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City | SUDBURY
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State | MA
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Zip | 01776-3368
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Country | US
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Telephone | 508-319-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 45 BIRCH RD
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City | FRAMINGHAM
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State | MA
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Zip | 01701-3517
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Country | US
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Telephone | 508-319-9056
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LACI L GENTRY
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Credential | LICSW
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Telephone | 508-319-9056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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