Provider Demographics
NPI:1801462197
Name:TOTAL METAMORPHOSIS LLC
Entity type:Organization
Organization Name:TOTAL METAMORPHOSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAKIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALUSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-795-4995
Mailing Address - Street 1:67 FOREST ST
Mailing Address - Street 2:SUITE 270 #573
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:978-482-7189
Mailing Address - Fax:
Practice Address - Street 1:67 FOREST ST
Practice Address - Street 2:SUITE 270 #573
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:978-795-4995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty