Provider Demographics
NPI:1467034108
Name:COMPLETE MENTAL WELLNESS, LLC
Entity Type:Organization
Organization Name:COMPLETE MENTAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-238-0270
Mailing Address - Street 1:25 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3124
Mailing Address - Country:US
Mailing Address - Phone:774-238-0270
Mailing Address - Fax:
Practice Address - Street 1:1 UNION PL
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4437
Practice Address - Country:US
Practice Address - Phone:774-238-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty