Provider Demographics
NPI:1104634062
Name:DRAGONFLY PATH
Entity type:Organization
Organization Name:DRAGONFLY PATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-320-5914
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-0017
Mailing Address - Country:US
Mailing Address - Phone:508-320-5914
Mailing Address - Fax:774-389-1711
Practice Address - Street 1:45 RIVER ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2666
Practice Address - Country:US
Practice Address - Phone:508-320-5914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty