Healthcare Provider Details

I. General information

NPI: 1235848805
Provider Name (Legal Business Name): WORCESTER HOLISTIC HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 MAIN ST STE H
NORTHBOROUGH MA
01532-1667
US

IV. Provider business mailing address

131 LINCOLN ST STE 1
WORCESTER MA
01605-2408
US

V. Phone/Fax

Practice location:
  • Phone: 774-317-8966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: PETER GAGLIARDO
Title or Position: OWNER
Credential:
Phone: 508-302-9836