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General NPI Number Information
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NPI Number | 1760145379
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Entity Type | Organization
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Legal Business Name | CREATIVE ISLAND THERAPY, LLC
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 3384 WOODS EDGE CIR STE 104
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-1367
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Country | US
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Telephone | 239-235-0522
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Fax | 239-235-0512
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Provider Business Mailing Address
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Address Line | 1212 NUUANU AVE
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City | HONOLULU
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State | HI
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Zip | 96817-4021
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Country | US
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Telephone | 239-235-0522
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Fax | 808-752-4155
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | LORINDA JEANNE ROY MORENO
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Credential | BCBA
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Telephone | 239-235-0522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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