Healthcare Provider Details

I. General information

NPI: 1508776022
Provider Name (Legal Business Name): BEAUTIFUL LIFE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2 FIELD AVE
HICKSVILLE NY
11801-5302
US

IV. Provider business mailing address

2 FIELD AVE
HICKSVILLE NY
11801-5302
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-4426
  • Fax:
Mailing address:
  • Phone: 623-975-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH FIORE
Title or Position: OWNER
Credential:
Phone: 623-975-4426