Healthcare Provider Details

I. General information

NPI: 1780452516
Provider Name (Legal Business Name): UDDINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KAYA GUZMANBLANCU
WILLEMSTAD CURACAO
00000
AN

IV. Provider business mailing address

PO BOX 6052
GLOUCESTER MA
01930-4752
US

V. Phone/Fax

Practice location:
  • Phone: 508-648-2299
  • Fax:
Mailing address:
  • Phone: 508-648-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHRUTI TEKWANI
Title or Position: PSYCHOTHERAPIST
Credential: LMHC
Phone: 508-648-2299