Provider Demographics
NPI:1326815515
Name:EMPOWERU THERAPY SERVICES LLC
Entity type:Organization
Organization Name:EMPOWERU THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HADAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-855-7799
Mailing Address - Street 1:437 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3632
Mailing Address - Country:US
Mailing Address - Phone:617-855-7799
Mailing Address - Fax:
Practice Address - Street 1:437 HIGH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3632
Practice Address - Country:US
Practice Address - Phone:617-855-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1306358452Medicaid