Provider Demographics
NPI:1013649029
Name:FLOURISH THERAPY CENTER
Entity Type:Organization
Organization Name:FLOURISH THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-974-4802
Mailing Address - Street 1:190 OLD DERBY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4066
Mailing Address - Country:US
Mailing Address - Phone:781-974-4802
Mailing Address - Fax:
Practice Address - Street 1:190 OLD DERBY ST STE 202
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4066
Practice Address - Country:US
Practice Address - Phone:781-974-4802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GINA CIPOLLA CONNOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty