Healthcare Provider Details

I. General information

NPI: 1073408209
Provider Name (Legal Business Name): SAGED SOUL HEALING & SELF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S BRIDGE DR
AGAWAM MA
01001-2015
US

IV. Provider business mailing address

706 NOTT ST
WETHERSFIELD CT
06109-1467
US

V. Phone/Fax

Practice location:
  • Phone: 413-244-4660
  • Fax:
Mailing address:
  • Phone: 860-913-8384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRYSTAL BARIFFE
Title or Position: FOUNDER/LEAD PRACTITIONER
Credential:
Phone: 860-913-8384