Healthcare Provider Details

I. General information

NPI: 1023928645
Provider Name (Legal Business Name): BRAINSPARK WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MAIN ST STE 1100
WORCESTER MA
01608-1759
US

IV. Provider business mailing address

370 MAIN ST STE 1100
WORCESTER MA
01608-1759
US

V. Phone/Fax

Practice location:
  • Phone: 617-297-7631
  • Fax:
Mailing address:
  • Phone: 617-297-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: SARLAH BERNARD
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 617-297-7631