Healthcare Provider Details

I. General information

NPI: 1942129374
Provider Name (Legal Business Name): TERRARISE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 BOYLSTON ST 5TH FL 1999
BOSTON MA
02116
US

IV. Provider business mailing address

867 BOYLSTON ST 5TH FL 1999
BOSTON MA
02116
US

V. Phone/Fax

Practice location:
  • Phone: 617-500-4088
  • Fax:
Mailing address:
  • Phone: 617-500-4088
  • 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: JASON LAWRENCE MADDEN
Title or Position: OWNER
Credential: MSW, LICSW
Phone: 617-500-4088