Provider Demographics
NPI:1477391456
Name:EMBODYMIND THERAPEUTICS LLC
Entity type:Organization
Organization Name:EMBODYMIND THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARTINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-390-2000
Mailing Address - Street 1:89 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1023
Mailing Address - Country:US
Mailing Address - Phone:413-270-2405
Mailing Address - Fax:
Practice Address - Street 1:89 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1023
Practice Address - Country:US
Practice Address - Phone:413-390-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty