Provider Demographics
NPI:1518511765
Name:WELLSPRING MENTORS LLC
Entity Type:Organization
Organization Name:WELLSPRING MENTORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON FINDLAY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, CCHP-MH, CCF
Authorized Official - Phone:617-516-4761
Mailing Address - Street 1:22 ELMORE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3624
Mailing Address - Country:US
Mailing Address - Phone:617-516-4761
Mailing Address - Fax:
Practice Address - Street 1:2075 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-3313
Practice Address - Country:US
Practice Address - Phone:617-516-4761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health