Provider Demographics
NPI:1669043410
Name:HEAD TO HEART, LLC
Entity Type:Organization
Organization Name:HEAD TO HEART, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSSOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-644-4250
Mailing Address - Street 1:46 BROOKSDALE RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1858
Mailing Address - Country:US
Mailing Address - Phone:617-644-4250
Mailing Address - Fax:
Practice Address - Street 1:46 BROOKSDALE RD APT 3
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1858
Practice Address - Country:US
Practice Address - Phone:617-644-4250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1174957682Medicaid