Healthcare Provider Details

I. General information

NPI: 1417879594
Provider Name (Legal Business Name): MILK THISTLE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 BELLUS RD
ASHFIELD MA
01330
US

IV. Provider business mailing address

PO BOX 472
ASHFIELD MA
01330-0472
US

V. Phone/Fax

Practice location:
  • Phone: 414-460-8388
  • Fax:
Mailing address:
  • Phone: 414-460-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: FINN PHOENIX
Title or Position: PROPRIETOR
Credential: LICSW, LCSW
Phone: 414-460-8388