Healthcare Provider Details

I. General information

NPI: 1578822151
Provider Name (Legal Business Name): WELLSPRING FARM LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 HILLER RD
ROCHESTER MA
02770-4023
US

IV. Provider business mailing address

42 HILLER RD
ROCHESTER MA
02770-4023
US

V. Phone/Fax

Practice location:
  • Phone: 508-763-5896
  • Fax: 508-763-5896
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number313342
License Number StateMA

VIII. Authorized Official

Name: JAMES VOGEL
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 508-763-5896