Provider Demographics
NPI:1063003622
Name:THE PATIENT PALETTE, CREATIVE ARTS THERAPY, PLLC
Entity Type:Organization
Organization Name:THE PATIENT PALETTE, CREATIVE ARTS THERAPY, PLLC
Other - Org Name:THE PATIENT PALETTE, CREATIVE ARTS THERAPY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER & ART THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRABILE
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT, ATR-BC
Authorized Official - Phone:347-927-6896
Mailing Address - Street 1:15 MAIDEN LN STE 1405
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5113
Mailing Address - Country:US
Mailing Address - Phone:347-927-6896
Mailing Address - Fax:
Practice Address - Street 1:15 MAIDEN LN STE 1405
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5113
Practice Address - Country:US
Practice Address - Phone:347-927-6896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty