Provider Demographics
NPI:1962862425
Name:THE HEALING JOURNEY LLC
Entity Type:Organization
Organization Name:THE HEALING JOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:585-281-9947
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:25 S. WEST ST.
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-0694
Mailing Address - Country:US
Mailing Address - Phone:585-281-9947
Mailing Address - Fax:
Practice Address - Street 1:25 S. WEST ST.
Practice Address - Street 2:
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-0614
Practice Address - Country:US
Practice Address - Phone:585-281-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077265-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831350503OtherINDIVIDUAL NPI