Provider Demographics
NPI:1275852097
Name:INSTITUTE FOR SEXUAL WELLNESS, INC
Entity Type:Organization
Organization Name:INSTITUTE FOR SEXUAL WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-479-4501
Mailing Address - Street 1:1233 HANCOCK ST
Mailing Address - Street 2:REAR
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4342
Mailing Address - Country:US
Mailing Address - Phone:617-479-4501
Mailing Address - Fax:617-479-8109
Practice Address - Street 1:1233 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4342
Practice Address - Country:US
Practice Address - Phone:617-479-4501
Practice Address - Fax:617-479-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207842102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty