Provider Demographics
NPI:1336976083
Name:THE THERAPY LAB, LLC
Entity type:Organization
Organization Name:THE THERAPY LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:787-628-2293
Mailing Address - Street 1:88 LAKE VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-4539
Mailing Address - Country:US
Mailing Address - Phone:787-628-2293
Mailing Address - Fax:
Practice Address - Street 1:7726 WINEGARD RD
Practice Address - Street 2:2ND FLOOR, UNIT#.
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809
Practice Address - Country:US
Practice Address - Phone:787-628-2293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty