Provider Demographics
NPI:1316398852
Name:DEARBORN WELLNESS, LLC
Entity Type:Organization
Organization Name:DEARBORN WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:857-288-8508
Mailing Address - Street 1:1266 FURNACE BROOK PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4789
Mailing Address - Country:US
Mailing Address - Phone:857-288-8508
Mailing Address - Fax:888-262-9456
Practice Address - Street 1:1266 FURNACE BROOK PKWY STE 307
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4789
Practice Address - Country:US
Practice Address - Phone:857-288-8508
Practice Address - Fax:888-262-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9599261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health