Healthcare Provider Details

I. General information

NPI: 1225895659
Provider Name (Legal Business Name): PUREWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CEDAR ST
WORCESTER MA
01609-4101
US

IV. Provider business mailing address

55 CEDAR ST
WORCESTER MA
01609-4101
US

V. Phone/Fax

Practice location:
  • Phone: 978-393-1434
  • Fax:
Mailing address:
  • Phone:
  • 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: NINA LOW
Title or Position: OWNER/MANAGER
Credential:
Phone: 978-393-1434