Provider Demographics
NPI:1356681894
Name:THE THERAPY ROOM
Entity Type:Organization
Organization Name:THE THERAPY ROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMASZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WAWRZYNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-435-0202
Mailing Address - Street 1:7 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2888
Mailing Address - Country:US
Mailing Address - Phone:617-435-0202
Mailing Address - Fax:855-288-2471
Practice Address - Street 1:7 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2888
Practice Address - Country:US
Practice Address - Phone:617-435-0202
Practice Address - Fax:855-288-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty