Provider Demographics
NPI:1093048787
Name:INTEGRATIVE THERAPIES, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:SHERRAD
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-770-1170
Mailing Address - Street 1:97 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2433
Mailing Address - Country:US
Mailing Address - Phone:617-770-1170
Mailing Address - Fax:617-770-1174
Practice Address - Street 1:97 HOLMES ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2433
Practice Address - Country:US
Practice Address - Phone:617-770-1170
Practice Address - Fax:617-770-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854542Medicaid
MA1854542Medicaid