Provider Demographics
NPI:1831802628
Name:RAY OF LIGHT WELLNESS LLC
Entity type:Organization
Organization Name:RAY OF LIGHT WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICSW
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:774-365-1212
Mailing Address - Street 1:3235 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1606
Mailing Address - Country:US
Mailing Address - Phone:774-365-1212
Mailing Address - Fax:
Practice Address - Street 1:3235 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1606
Practice Address - Country:US
Practice Address - Phone:774-365-1212
Practice Address - Fax:508-567-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health