Healthcare Provider Details

I. General information

NPI: 1407656309
Provider Name (Legal Business Name): JEUDEMONIA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 CUMMINS HWY # B
BOSTON MA
02126-1200
US

IV. Provider business mailing address

555 N MAIN ST # 14151A
PROVIDENCE RI
02904-5722
US

V. Phone/Fax

Practice location:
  • Phone: 617-921-6984
  • Fax:
Mailing address:
  • Phone: 617-921-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JHANEV ALLEN
Title or Position: CLINICAL DIRECTOR
Credential: PSYD
Phone: 617-921-6984