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Organization
MA MC SPROUT 1 LLC
Active
Organization
MA MC SPROUT 1 LLC
Active
Other names
Sprout Therapy, Elemy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RAGHEB (COO)
(786) 210-8200
Entity
Organization
Contact information
Practice address
90 CANAL ST, BOSTON, MA 02114-2018
(833) 991-2368
(929) 384-7193
Mailing address
6303 BLUE LAGOON DR STE 400, MIAMI, FL 33126-6040
(833) 991-2368
(929) 384-7193
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/11/2020
Last updated
11/05/2021
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