Provider Demographics
NPI:1558247460
Name:INTEGRATIVE THERAPY FOR CHANGE
Entity type:Organization
Organization Name:INTEGRATIVE THERAPY FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:GUERTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-396-5356
Mailing Address - Street 1:58 CONSTITUTION ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-2121
Mailing Address - Country:US
Mailing Address - Phone:401-396-5356
Mailing Address - Fax:401-396-5356
Practice Address - Street 1:58 CONSTITUTION ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-2121
Practice Address - Country:US
Practice Address - Phone:401-396-5356
Practice Address - Fax:401-396-5356
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