MEDICARE: EMBODIED CREATIVE ARTS THERAPY PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1851921084	OTHER		NPPES

General Provider Information

NPI Number	:	1982345385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBODIED CREATIVE ARTS THERAPY PLLC

Provider Business Mailing Address
First Line	:	1858 PLEASANTVILLE RD STE 121
Second Line	:
City	:	BRIARCLIFF MANOR
State	:	NY
Zip	:	10510-1025
Country	:	US
Telephone Number	:	914-257-3732
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W 27TH ST FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6241
Country	:	US
Telephone Number	:	914-257-3732
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER STERLING
Credential	:	LCAT
Telephone Number	:	914-257-3732

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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