Provider Demographics
NPI:1639896608
Name:STOUCKWELLNESS
Entity Type:Organization
Organization Name:STOUCKWELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:301-802-2414
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-0005
Mailing Address - Country:US
Mailing Address - Phone:301-802-2414
Mailing Address - Fax:
Practice Address - Street 1:3 TREMONT PL
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4113
Practice Address - Country:US
Practice Address - Phone:301-802-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health