Healthcare Provider Details

I. General information

NPI: 1457280752
Provider Name (Legal Business Name): WAVES WITHIN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 MAIN ST STE 6B
MEDWAY MA
02053-1533
US

IV. Provider business mailing address

163 MAIN ST STE 6B
MEDWAY MA
02053-1533
US

V. Phone/Fax

Practice location:
  • Phone: 774-277-9505
  • Fax:
Mailing address:
  • Phone: 774-277-9505
  • 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: JENNIFER LEACH
Title or Position: CLINICAL SOCIAL WORKER
Credential: LICSW
Phone: 774-993-9762