Provider Demographics
NPI:1851007686
Name:REINVIGORATE WELLNESS
Entity Type:Organization
Organization Name:REINVIGORATE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-870-6975
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-0168
Mailing Address - Country:US
Mailing Address - Phone:978-870-6975
Mailing Address - Fax:
Practice Address - Street 1:19 SCHURMAN DR
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1620
Practice Address - Country:US
Practice Address - Phone:978-870-6975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health