Provider Demographics
NPI:1558110320
Name:INTEGRATIVE CREATIVE ARTS THERAPY, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE CREATIVE ARTS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHET
Authorized Official - Suffix:
Authorized Official - Credentials:MPS
Authorized Official - Phone:631-278-6528
Mailing Address - Street 1:109 BROWNS RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 BROWNS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1852
Practice Address - Country:US
Practice Address - Phone:631-759-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty