Provider Demographics
NPI:1659815819
Name:REALIZED PERFORMANCE, INC.
Entity Type:Organization
Organization Name:REALIZED PERFORMANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:978-408-9962
Mailing Address - Street 1:234 CABOT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5723
Mailing Address - Country:US
Mailing Address - Phone:978-408-9962
Mailing Address - Fax:978-969-3407
Practice Address - Street 1:234 CABOT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5723
Practice Address - Country:US
Practice Address - Phone:978-408-9962
Practice Address - Fax:978-969-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty