Healthcare Provider Details

I. General information

NPI: 1467399642
Provider Name (Legal Business Name): HAVEN RISE WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 S MAIN ST
GARDNER MA
01440-3328
US

IV. Provider business mailing address

278 S MAIN ST
GARDNER MA
01440-3328
US

V. Phone/Fax

Practice location:
  • Phone: 508-252-0957
  • Fax:
Mailing address:
  • Phone: 508-252-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROSY BRUNOT
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 508-252-0957