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General NPI Number Information
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NPI Number | 1972834026
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Entity Type | Organization
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Legal Business Name | ALCHEMY ACUPUNCTURE PSYCHOTHERAPY
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 5607 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34207-3516
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Country | US
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Telephone | 941-779-7443
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Fax |
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Provider Business Mailing Address
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Address Line | 7711 DESOTO MEMORIAL HWY
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City | BRADENTON
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State | FL
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Zip | 34209-9789
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Country | US
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Telephone | 941-779-7443
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA M GROSSMAN
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Credential | DOM, AP, LCSW
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Telephone | 941-779-7443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1030424
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2683
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 9349
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License Number State | FL
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