Provider Demographics
NPI:1114539467
Name:PERSONAL INSIGHT THERAPY, LLC
Entity Type:Organization
Organization Name:PERSONAL INSIGHT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:VALIN
Authorized Official - Last Name:NISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-208-0558
Mailing Address - Street 1:59 CUTTER ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3644
Mailing Address - Country:US
Mailing Address - Phone:617-406-8830
Mailing Address - Fax:
Practice Address - Street 1:226 LOWELL ST STE B7
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-3073
Practice Address - Country:US
Practice Address - Phone:781-208-0558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty