Healthcare Provider Details

I. General information

NPI: 1063169654
Provider Name (Legal Business Name): WELLNESS FOR OUR FUTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 DORCHESTER AVE
BOSTON MA
02122-1386
US

IV. Provider business mailing address

1452 DORCHESTER AVE
BOSTON MA
02122-1386
US

V. Phone/Fax

Practice location:
  • Phone: 781-817-3956
  • Fax:
Mailing address:
  • Phone: 781-817-3956
  • 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: MRS. TRACEY TALDON
Title or Position: CEO/OWNER/PSYCHOTHERAPIST
Credential: LICSW
Phone: 857-221-0451