Provider Demographics
NPI:1336786482
Name:INTUITIVE WELLNESS CREATIVE ARTS
Entity Type:Organization
Organization Name:INTUITIVE WELLNESS CREATIVE ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREATIVE ARTS THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT
Authorized Official - Phone:631-848-8977
Mailing Address - Street 1:3980 EVE DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3980 EVE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1553
Practice Address - Country:US
Practice Address - Phone:631-848-8977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1225683428Medicaid