Provider Demographics
NPI:1346126380
Name:EVERLAST THERAPY LLC
Entity type:Organization
Organization Name:EVERLAST THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER SOCIAL WORKER (LMSW
Authorized Official - Prefix:
Authorized Official - First Name:CIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-778-0563
Mailing Address - Street 1:214 QUINN AVE
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1527
Mailing Address - Country:US
Mailing Address - Phone:989-778-0563
Mailing Address - Fax:
Practice Address - Street 1:214 QUINN AVE
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1527
Practice Address - Country:US
Practice Address - Phone:989-778-0563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty