Provider Demographics
NPI:1336791482
Name:SPOTTED RABBIT CREATIVE ARTS THERAPY, PLLC
Entity Type:Organization
Organization Name:SPOTTED RABBIT CREATIVE ARTS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREN
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT
Authorized Official - Phone:585-430-9877
Mailing Address - Street 1:2376 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3032
Mailing Address - Country:US
Mailing Address - Phone:585-430-9877
Mailing Address - Fax:585-200-3215
Practice Address - Street 1:2376 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3032
Practice Address - Country:US
Practice Address - Phone:585-430-9877
Practice Address - Fax:585-486-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty