Provider Demographics
NPI:1053982850
Name:KALEIDOSCOPE GROWTH, LLC
Entity type:Organization
Organization Name:KALEIDOSCOPE GROWTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-529-8513
Mailing Address - Street 1:23 HOLLY HOUSE CT APT B5
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3642
Mailing Address - Country:US
Mailing Address - Phone:860-483-8529
Mailing Address - Fax:
Practice Address - Street 1:23 HOLLY HOUSE CT APT B5
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3642
Practice Address - Country:US
Practice Address - Phone:860-483-8529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty