Healthcare Provider Details

I. General information

NPI: 1558270207
Provider Name (Legal Business Name): NORTHLINE WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 HIGHLAND AVE # 1268
NEEDHAM HEIGHTS MA
02494-3025
US

IV. Provider business mailing address

163 HIGHLAND AVE # 1268
NEEDHAM HEIGHTS MA
02494-3025
US

V. Phone/Fax

Practice location:
  • Phone: 540-429-1903
  • Fax:
Mailing address:
  • Phone: 540-429-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BEATRICE A AZAH
Title or Position: OWNER/PMHNP-BC
Credential: PMHNP-BC
Phone: 540-429-1903