Provider Demographics
NPI:1053932046
Name:RELATESPACE LLC
Entity type:Organization
Organization Name:RELATESPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-366-2550
Mailing Address - Street 1:8709 BRAY VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1713
Mailing Address - Country:US
Mailing Address - Phone:617-366-2550
Mailing Address - Fax:617-340-3733
Practice Address - Street 1:75 ARLINGTON ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3936
Practice Address - Country:US
Practice Address - Phone:617-366-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119105AMedicaid