Healthcare Provider Details

I. General information

NPI: 1174384572
Provider Name (Legal Business Name): FAMILYWELL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 03/03/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TARRYTOWN RD
MANCHESTER NH
03103-2713
US

IV. Provider business mailing address

144 OAKLAND ST
WELLESLEY MA
02481-5323
US

V. Phone/Fax

Practice location:
  • Phone: 864-336-2731
  • Fax: 833-740-3387
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SCHIFFMAN GAULTON
Title or Position: CEO
Credential: MD
Phone: 267-432-4757