MEDICARE: NORTHERN LIGHTS WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1063307999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN LIGHTS WELLNESS PLLC

Provider Business Mailing Address
First Line	:	1321 RIVERDALE ST
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-4916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 RIVERDALE ST
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-4916
Country	:	US
Telephone Number	:	469-684-4410
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	HAYLEY PEPIN
Credential	:	LICSW
Telephone Number	:	469-684-4410

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	07/04/2025

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