Provider Demographics
NPI:1629896972
Name:CHANGING PERSPECTIVE LLC
Entity type:Organization
Organization Name:CHANGING PERSPECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, DNP
Authorized Official - Phone:203-454-0505
Mailing Address - Street 1:CHANGING PERSPECTIVELLC
Mailing Address - Street 2:1465 POST ED EAST
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5528
Mailing Address - Country:US
Mailing Address - Phone:203-454-0505
Mailing Address - Fax:
Practice Address - Street 1:CHANGING PERSPECTIVE LLC
Practice Address - Street 2:1465 POST RD EAST
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5528
Practice Address - Country:US
Practice Address - Phone:203-454-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty