Provider Demographics
NPI:1760145379
Name:CREATIVE ISLAND THERAPY, LLC
Entity type:Organization
Organization Name:CREATIVE ISLAND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORINDA
Authorized Official - Middle Name:JEANNE ROY
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:239-235-0522
Mailing Address - Street 1:1212 NUUANU AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4021
Mailing Address - Country:US
Mailing Address - Phone:239-235-0522
Mailing Address - Fax:808-752-4155
Practice Address - Street 1:3384 WOODS EDGE CIR STE 104
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1367
Practice Address - Country:US
Practice Address - Phone:239-235-0522
Practice Address - Fax:239-235-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty