Healthcare Provider Details

I. General information

NPI: 1063325017
Provider Name (Legal Business Name): RESET PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GREEN FARMS RD
WORCESTER MA
01605-1001
US

IV. Provider business mailing address

25 GREEN FARMS RD
WORCESTER MA
01605-1001
US

V. Phone/Fax

Practice location:
  • Phone: 508-556-0106
  • Fax: 800-783-9331
Mailing address:
  • Phone: 508-556-0106
  • Fax: 800-783-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUSSIE KONDO
Title or Position: CEO
Credential:
Phone: 508-556-0106