Provider Demographics
NPI:1386245546
Name:ACTIVMATTERS OF THE BRAIN LLC
Entity type:Organization
Organization Name:ACTIVMATTERS OF THE BRAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCRC,AS,CRQM,CDP
Authorized Official - Phone:603-319-8863
Mailing Address - Street 1:421 MERRIMACK ST STE 203
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5864
Mailing Address - Country:US
Mailing Address - Phone:978-655-7155
Mailing Address - Fax:
Practice Address - Street 1:421 MERRIMACK ST STE 203
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5864
Practice Address - Country:US
Practice Address - Phone:978-655-7155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty