| Creative Healing Space, LLC | |
|
235 Emmett St Fall River MA 02721-3523 | |
| (774) 264-3481 | |
| Not Available |
| Full Name | Creative Healing Space, LLC |
|---|---|
| Speciality | Counselor |
| Location | 235 Emmett St, Fall River, Massachusetts |
| Authorized Official Name and Position | Jessica Baraby (OWNER) |
| Authorized Official Contact | 7742641249 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Healing Space, LLC 875 State Rd Unit 11 #126 Westport MA 02790-2853 Ph: (774) 264-3481 | Creative Healing Space, LLC 235 Emmett St Fall River MA 02721-3523 Ph: (774) 264-3481 |
| NPI Number | 1174393771 |
|---|---|
| Provider Enumeration Date | 01/04/2024 |
| Last Update Date | 01/04/2024 |
| Certification Date | 01/04/2024 |
| Medicare PECOS PAC ID | 2466891601 |
|---|---|
| Medicare Enrollment ID | O20240419002317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174393771 | NPI | - | NPPES |
| Provider Name | Jessica Baraby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679039705 PECOS PAC ID: 9133596364 Enrollment ID: I20221101001688 |
| Provider Name | Jessica Lyn Gagne-griffin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407464076 PECOS PAC ID: 7113377235 Enrollment ID: I20240102000917 |
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