Provider Demographics
NPI:1902137623
Name:THERAPY FOR INTENTIONAL LIVING, INC.
Entity Type:Organization
Organization Name:THERAPY FOR INTENTIONAL LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:RIGGIO
Authorized Official - Last Name:TOSI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-724-9039
Mailing Address - Street 1:50 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2452
Mailing Address - Country:US
Mailing Address - Phone:781-724-9039
Mailing Address - Fax:781-990-3051
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 408-S
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:781-724-9039
Practice Address - Fax:781-990-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020919251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health