Provider Demographics
NPI:1023382058
Name:NEW LIFE COUNSELING & WELLNESS CENTER
Entity Type:Organization
Organization Name:NEW LIFE COUNSELING & WELLNESS CENTER
Other - Org Name:NEW LIFE COUNSELING & WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-986-4800
Mailing Address - Street 1:9 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2424
Mailing Address - Country:US
Mailing Address - Phone:781-986-4800
Mailing Address - Fax:
Practice Address - Street 1:9 CANTON ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-986-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA410599104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty