Indigo Art Center Inc

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

INDIGO ART CENTER INC

Practice address

4282 Herschel St
Jacksonville, FL 32210-2247

Phone

(904) 520-4191

Fax

(904) 441-6901

NPI assigned

Nov 16, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Elizabeth Desousa, MS, ATR-BCNPI 1124513106

Title

Co-Founder, President

Phone

(904) 520-4191

Specialties & licenses 3

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Elizabeth Desousa, MS, ATR

  • Art Therapist
  • Jacksonville, FL
  • NPI 1124513106
  NPD Authorized official
• Sarah Anne Beaman, ATR-BC

  • Art Therapist
  • Jacksonville, FL
  • NPI 1730658402
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1659973477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4169 SHIRLEY AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102229",
            "telephone_number": "904-520-4191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4282 HERSCHEL ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102247",
            "telephone_number": "904-520-4191",
            "fax_number": "904-441-6901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO ART CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "DESOUSA",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "CO-FOUNDER, PRESIDENT",
        "authorized_official_telephone_number": "904-520-4191",
        "authorized_official_credential": "MS, ATR-BC"
    },
    "taxonomies": [
        {
            "code": "221700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Art Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Recreation Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Independence Youth Center
• Independent Feeding Device, LLC
• Independent Pediatricians of North FL Inc
• Indian Rehabilitation Center, Inc
• Carolyn Indianos, MD
• Indigo Art Therapy Studio LLC
• Jenna Marie Indingaro, CRNA
• Lori Indriolo, PHARMD
• Klaudia Ruby Inesta
• Ramses E Infante Palacios

• Developmental Disabilities Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.