Provider Demographics
NPI:1821606856
Name:THERAPEUTIC SUCCESS LLC
Entity Type:Organization
Organization Name:THERAPEUTIC SUCCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERVIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:917-474-1172
Mailing Address - Street 1:310 WICKS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1512
Mailing Address - Country:US
Mailing Address - Phone:917-474-1172
Mailing Address - Fax:
Practice Address - Street 1:310 WICKS AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1512
Practice Address - Country:US
Practice Address - Phone:917-474-1172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency