Provider Demographics
NPI:1750953253
Name:INTEGRATED CHILDREN'S THERAPIES, INC.
Entity type:Organization
Organization Name:INTEGRATED CHILDREN'S THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN GORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-568-8800
Mailing Address - Street 1:2 COOLIDGE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1459
Mailing Address - Country:US
Mailing Address - Phone:978-568-8800
Mailing Address - Fax:978-568-8877
Practice Address - Street 1:2 COOLIDGE ST STE 201
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1459
Practice Address - Country:US
Practice Address - Phone:978-568-8800
Practice Address - Fax:978-568-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty