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General NPI Number Information
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NPI Number | 1750261921
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Entity Type | Organization
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Legal Business Name | COGNITIVE CANVAS, LLC
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Dates
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Enumeration Date | 09/06/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 2 ELM SQ STE 311
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City | ANDOVER
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State | MA
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Zip | 01810-3668
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Country | US
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Telephone | 978-852-0727
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Fax |
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Provider Business Mailing Address
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Address Line | 2 ELM SQ STE 311
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City | ANDOVER
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State | MA
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Zip | 01810-3668
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Country | US
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Telephone | 978-219-4256
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HILLARY GLICK
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Credential |
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Telephone | 978-219-4256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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