Provider Demographics
NPI:1619717089
Name:THE TRANSFORMATION COLLECTIVE LLC
Entity type:Organization
Organization Name:THE TRANSFORMATION COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-735-8951
Mailing Address - Street 1:36 HORNBINE RD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3618
Mailing Address - Country:US
Mailing Address - Phone:800-735-8951
Mailing Address - Fax:
Practice Address - Street 1:1154 RIVERSIDE AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-2841
Practice Address - Country:US
Practice Address - Phone:800-735-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty