Provider Demographics
NPI:1992503759
Name:BLUE GREEN CREATIVE ARTS THERAPY, PLLC
Entity type:Organization
Organization Name:BLUE GREEN CREATIVE ARTS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER - MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAEIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLJI
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT, ATR-BC
Authorized Official - Phone:929-722-1316
Mailing Address - Street 1:PO BOX 150525
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-0525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 W 9TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3936
Practice Address - Country:US
Practice Address - Phone:929-722-1316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)