Provider Demographics
NPI:1144797713
Name:PSYCHOTHERAPY & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-780-6415
Mailing Address - Street 1:69 MOFFAT RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1114
Mailing Address - Country:US
Mailing Address - Phone:617-780-6415
Mailing Address - Fax:
Practice Address - Street 1:42 WASHINGTON ST STE 210
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-1817
Practice Address - Country:US
Practice Address - Phone:617-780-6415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)