Healthcare Provider Details

I. General information

NPI: 1124730445
Provider Name (Legal Business Name): QUANTUM HEALING UNIVERSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 BROADWAY SUITE 303
SAUGUS MA
01906-0000
US

IV. Provider business mailing address

999 BROADWAY SUITE 303
SAUGUS MA
01906-0000
US

V. Phone/Fax

Practice location:
  • Phone: 781-558-1561
  • Fax: 781-558-1561
Mailing address:
  • Phone: 781-558-1561
  • Fax: 781-558-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. CILEIMAR S OLIVEIRA
Title or Position: MANAGER
Credential:
Phone: 781-558-1561