Provider Demographics
NPI:1972825917
Name:SAFE STEPS WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SAFE STEPS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MICKA-PICKUNKA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, OTR/L
Authorized Official - Phone:413-977-2793
Mailing Address - Street 1:5 CROWLEY RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9637
Mailing Address - Country:US
Mailing Address - Phone:413-977-2793
Mailing Address - Fax:413-527-5284
Practice Address - Street 1:5 CROWLEY RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-9637
Practice Address - Country:US
Practice Address - Phone:413-977-2793
Practice Address - Fax:413-527-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty