Provider Demographics
NPI:1972834026
Name:ALCHEMY ACUPUNCTURE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:ALCHEMY ACUPUNCTURE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP, LCSW
Authorized Official - Phone:941-779-7443
Mailing Address - Street 1:7711 DESOTO MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-9789
Mailing Address - Country:US
Mailing Address - Phone:941-779-7443
Mailing Address - Fax:
Practice Address - Street 1:5607 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3516
Practice Address - Country:US
Practice Address - Phone:941-779-7443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10304241041C0700X
FLSW 93491041C0700X
FLAP2683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty