Healthcare Provider Details

I. General information

NPI: 1639893514
Provider Name (Legal Business Name): SERENITY THERAPY AND WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N MAIN ST STE 301
FALL RIVER MA
02720-2133
US

IV. Provider business mailing address

538 CENTER ST
FALL RIVER MA
02724-2765
US

V. Phone/Fax

Practice location:
  • Phone: 774-930-7142
  • Fax:
Mailing address:
  • Phone: 774-930-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA O'BRIEN
Title or Position: PRESIDENT
Credential: LICSW
Phone: 774-930-7142