Provider Demographics
NPI:1265974489
Name:INNOVATIVE THERAPY SOLUTIONS
Entity type:Organization
Organization Name:INNOVATIVE THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERPAIST LICSW
Authorized Official - Prefix:MR
Authorized Official - First Name:T
Authorized Official - Middle Name:MICELLI
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-344-3226
Mailing Address - Street 1:452 LIME ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039-2404
Mailing Address - Country:US
Mailing Address - Phone:860-596-4436
Mailing Address - Fax:
Practice Address - Street 1:314 MAIN ST
Practice Address - Street 2:OFFICE 8
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1744
Practice Address - Country:US
Practice Address - Phone:413-344-3226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1168911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty