Provider Demographics
NPI:1285188102
Name:EMBRACING THE CREATIVE CHILD, LLC
Entity Type:Organization
Organization Name:EMBRACING THE CREATIVE CHILD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-801-4380
Mailing Address - Street 1:55 DEER PARK DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3198
Mailing Address - Country:US
Mailing Address - Phone:413-801-4380
Mailing Address - Fax:
Practice Address - Street 1:55 DEER PARK DR
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-3198
Practice Address - Country:US
Practice Address - Phone:413-525-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA940103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty