MEDICARE: GROUNDED INTERVENTIONS PSYCHIATRIC AND WELLNESS SERVICES

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1528838737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROUNDED INTERVENTIONS PSYCHIATRIC AND WELLNESS SERVICES

Provider Business Mailing Address
First Line	:	104 CHARLES ELDRIDGE RD STE 6
Second Line	:
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1388
Country	:	US
Telephone Number	:	774-406-4777
Fax Number	:	508-644-3921

Provider Business Practice Location Address
First Line	:	104 CHARLES ELDRIDGE RD STE 6
Second Line	:
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1388
Country	:	US
Telephone Number	:	774-406-4777
Fax Number	:	508-644-3921

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	MS. RENEE M GARBITT
Credential	:	LMHC, C-NP, PMHNP-BC
Telephone Number	:	508-886-3921

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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