Provider Demographics
NPI:1831797539
Name:NEW ENGLAND HOLISTIC WELL-BEING CENTER LLC
Entity type:Organization
Organization Name:NEW ENGLAND HOLISTIC WELL-BEING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-337-0024
Mailing Address - Street 1:4 DOUBLEDAY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1405
Mailing Address - Country:US
Mailing Address - Phone:860-337-0024
Mailing Address - Fax:
Practice Address - Street 1:4 DOUBLEDAY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1405
Practice Address - Country:US
Practice Address - Phone:860-337-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health