Provider Demographics
NPI:1346959186
Name:CREATIVE HEALING PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:CREATIVE HEALING PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:ADINA
Authorized Official - Last Name:RAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:917-731-0647
Mailing Address - Street 1:1035 HOOPER AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8355
Mailing Address - Country:US
Mailing Address - Phone:917-731-0647
Mailing Address - Fax:
Practice Address - Street 1:1035 HOOPER AVE STE 2B
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8355
Practice Address - Country:US
Practice Address - Phone:917-731-0647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty