Provider Demographics
NPI:1366254112
Name:DIVINE FLOW HEALING LLC
Entity type:Organization
Organization Name:DIVINE FLOW HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-577-6910
Mailing Address - Street 1:140 DEBS PL APT 25D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2547
Mailing Address - Country:US
Mailing Address - Phone:917-577-6910
Mailing Address - Fax:
Practice Address - Street 1:444 E BOSTON POST RD STE 206
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3704
Practice Address - Country:US
Practice Address - Phone:917-577-6910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty