MEDICARE: CREATIVE ART THERAPIES AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164231973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE ART THERAPIES AND WELLNESS

Provider Business Mailing Address
First Line	:	116 NORMANDY RD
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-1229
Country	:	US
Telephone Number	:	413-686-0031
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 DWIGHT RD STE 104
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-1769
Country	:	US
Telephone Number	:	413-686-0031
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	SARAH SHUBE
Credential	:
Telephone Number	:	413-686-0031

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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Directions to “CREATIVE ART THERAPIES AND WELLNESS ” Practice Location

Language	Start Address	Practice Location

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