Provider Demographics
NPI:1265987580
Name:THE WOMAN AT THE WELL, INC
Entity type:Organization
Organization Name:THE WOMAN AT THE WELL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:J
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-823-9355
Mailing Address - Street 1:19 COURT ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3248
Mailing Address - Country:US
Mailing Address - Phone:508-823-9355
Mailing Address - Fax:508-823-9357
Practice Address - Street 1:19 COURT ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3248
Practice Address - Country:US
Practice Address - Phone:508-823-9355
Practice Address - Fax:508-823-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty