Provider Demographics
NPI:1790549954
Name:AUTHENTIC RECLAIMED LLC
Entity Type:Organization
Organization Name:AUTHENTIC RECLAIMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEAR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-688-2249
Mailing Address - Street 1:101 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2011
Mailing Address - Country:US
Mailing Address - Phone:617-688-2249
Mailing Address - Fax:
Practice Address - Street 1:101 EVERETT ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2011
Practice Address - Country:US
Practice Address - Phone:617-688-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health