Provider Demographics
NPI:1891307187
Name:C.L.U.B BLESSED WEIGHT MANAGEMENT INC.
Entity Type:Organization
Organization Name:C.L.U.B BLESSED WEIGHT MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FITNESS & WEIGHT MANAGEMENT COACH
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BARBOZA
Authorized Official - Suffix:
Authorized Official - Credentials:NUTRITION SPECIALIST
Authorized Official - Phone:774-379-9761
Mailing Address - Street 1:102 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1505
Mailing Address - Country:US
Mailing Address - Phone:774-379-9761
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4016
Practice Address - Country:US
Practice Address - Phone:774-379-9761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty