Provider Demographics
NPI:1801518006
Name:WILDFLOWER COUNSELING & PLAY THERAPY
Entity type:Organization
Organization Name:WILDFLOWER COUNSELING & PLAY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSAMPIERI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-930-2272
Mailing Address - Street 1:95 GOLDFINCH DR
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-6134
Mailing Address - Country:US
Mailing Address - Phone:508-930-2272
Mailing Address - Fax:
Practice Address - Street 1:20 SCOTLAND BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-4303
Practice Address - Country:US
Practice Address - Phone:508-930-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty