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NPI Code Detail

MEDICARE: CREATIVE INTERVENTIONS, LLC

MEDICARE: CREATIVE INTERVENTIONS, LLC
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1740438597
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATIVE INTERVENTIONS, LLC
Provider Business Mailing Address
First Line : PO BOX 367
Second Line :
City : WINDSOR
State : CT
Zip : 06095-0367
Country : US
Telephone Number : 860-413-9538
Fax Number : 860-874-5119
Provider Business Practice Location Address
First Line : 835 BLOOMFIELD AVE
Second Line :
City : WINDSOR
State : CT
Zip : 06095-2363
Country : US
Telephone Number : 860-413-9538
Fax Number :
Authorized Official
Title or Position : BUSINESS DIRECTOR
Name : SCOTT LEVINE
Credential :
Telephone Number : 860-413-9536
Provider Enumeration Date : 09/05/2008
Last Update Date : 04/11/2023

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