Provider Demographics
NPI:1568224970
Name:WELLWORTH HEALTH, INC.
Entity Type:Organization
Organization Name:WELLWORTH HEALTH, INC.
Other - Org Name:WELLWORTH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-913-3898
Mailing Address - Street 1:3523 CROWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4729
Mailing Address - Country:US
Mailing Address - Phone:760-390-2698
Mailing Address - Fax:
Practice Address - Street 1:3523 CROWELL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4729
Practice Address - Country:US
Practice Address - Phone:760-390-2698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty