Provider Demographics
NPI:1205509239
Name:WELLSPRING RESTORATIVE COUNSELING LLC
Entity type:Organization
Organization Name:WELLSPRING RESTORATIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSOZI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-231-0727
Mailing Address - Street 1:17 IRVING RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1242
Mailing Address - Country:US
Mailing Address - Phone:617-231-0727
Mailing Address - Fax:
Practice Address - Street 1:17 IRVING RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1242
Practice Address - Country:US
Practice Address - Phone:617-231-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty