Provider Demographics
NPI:1295274694
Name:PSYCHIATRIC WELLNESS CENTER
Entity type:Organization
Organization Name:PSYCHIATRIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SADAT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:603-310-5027
Mailing Address - Street 1:15 CONSTITUTION DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6042
Mailing Address - Country:US
Mailing Address - Phone:603-310-5027
Mailing Address - Fax:603-218-6187
Practice Address - Street 1:15 CONSTITUTION DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6042
Practice Address - Country:US
Practice Address - Phone:603-310-5027
Practice Address - Fax:603-218-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07497723363LP0808X
NH07484923363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty