MEDICARE: PSYCHOTHERAPY & WELLNESS CENTER, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1144797713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOTHERAPY & WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	69 MOFFAT RD
Second Line	:
City	:	WABAN
State	:	MA
Zip	:	02468-1114
Country	:	US
Telephone Number	:	617-780-6415
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 WASHINGTON ST STE 210
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1817
Country	:	US
Telephone Number	:	617-780-6415
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SHIRI KESSEL
Credential	:	LICSW
Telephone Number	:	617-780-6415

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	04/12/2019

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