Provider Demographics
NPI:1225327760
Name:REVELATIONS; TALK THERAPY, LLC
Entity Type:Organization
Organization Name:REVELATIONS; TALK THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-682-0823
Mailing Address - Street 1:40 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3608
Mailing Address - Country:US
Mailing Address - Phone:671-682-0823
Mailing Address - Fax:671-886-5105
Practice Address - Street 1:40 WARREN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3608
Practice Address - Country:US
Practice Address - Phone:671-682-0823
Practice Address - Fax:671-886-5105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REVELATIONS; TALK THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty