1902137623 NPI number — THERAPY FOR INTENTIONAL LIVING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902137623 NPI number — THERAPY FOR INTENTIONAL LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY FOR INTENTIONAL LIVING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902137623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 JERSEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARBLEHEAD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01945-2452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-724-9039
Provider Business Mailing Address Fax Number:
781-990-3051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 CUMMINGS CTR
Provider Second Line Business Practice Location Address:
SUITE 408-S
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915-6198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-724-9039
Provider Business Practice Location Address Fax Number:
781-990-3051
Provider Enumeration Date:
01/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TOSI
Authorized Official First Name:
ELISSA
Authorized Official Middle Name:
RIGGIO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-724-9039

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1020919 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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