Provider Demographics
NPI:1619400652
Name:WELLNESS WITHIN LLC
Entity Type:Organization
Organization Name:WELLNESS WITHIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:732-309-9016
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2392
Mailing Address - Country:US
Mailing Address - Phone:413-209-7796
Mailing Address - Fax:413-200-3095
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2392
Practice Address - Country:US
Practice Address - Phone:413-209-7796
Practice Address - Fax:413-200-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1190111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty