Provider Demographics
NPI:1588202345
Name:LIFE TRANSITIONS THERAPY, LLC
Entity Type:Organization
Organization Name:LIFE TRANSITIONS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-319-9056
Mailing Address - Street 1:45 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3517
Mailing Address - Country:US
Mailing Address - Phone:508-319-9056
Mailing Address - Fax:
Practice Address - Street 1:730 BOSTON POST RD UNIT SUITE26
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3368
Practice Address - Country:US
Practice Address - Phone:508-319-9056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health