Healthcare Provider Details

I. General information

NPI: 1093496002
Provider Name (Legal Business Name): INNOVATIVE HEALTH AND WELL-BEING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 WASHINGTON ST UNIT 1202
NORTH EASTON MA
02356-1148
US

IV. Provider business mailing address

244 WASHINGTON ST UNIT 1202
NORTH EASTON MA
02356-1148
US

V. Phone/Fax

Practice location:
  • Phone: 781-801-4248
  • Fax:
Mailing address:
  • Phone: 781-801-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GREGORY
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 781-801-4248