Provider Demographics
NPI:1598463838
Name:SOLACE DEVELOPMENTAL ASSESSMENT & THERAPY
Entity Type:Organization
Organization Name:SOLACE DEVELOPMENTAL ASSESSMENT & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-845-2434
Mailing Address - Street 1:111 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:S HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2213
Mailing Address - Country:US
Mailing Address - Phone:612-845-2434
Mailing Address - Fax:
Practice Address - Street 1:266 CABOT ST STE 5
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3368
Practice Address - Country:US
Practice Address - Phone:612-405-4138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty