Provider Demographics
NPI:1255894903
Name:STILL MOTION THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:STILL MOTION THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:MEIDANIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-858-8017
Mailing Address - Street 1:PO BOX: 470602
Mailing Address - Street 2:207 WASHINGTON ST.
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-858-8017
Mailing Address - Fax:617-207-9709
Practice Address - Street 1:92 MERRIMACK ST STE 2
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6217
Practice Address - Country:US
Practice Address - Phone:617-858-6916
Practice Address - Fax:617-207-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1902353758OtherBAY STATE COMMUNITY SERVICES