Healthcare Provider Details

I. General information

NPI: 1033939327
Provider Name (Legal Business Name): FERNWOOD HOLISTIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 BOSTON POST RD
WESTBROOK CT
06498-2171
US

IV. Provider business mailing address

1921 BOSTON POST RD UNIT 2&3
WESTBROOK CT
06498-2171
US

V. Phone/Fax

Practice location:
  • Phone: 860-661-5824
  • Fax: 860-661-5843
Mailing address:
  • Phone: 860-661-5824
  • Fax: 860-661-5843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DONNA ALQUEZA
Title or Position: BILLING SPECIALIST
Credential:
Phone: 860-961-8583