Healthcare Provider Details

I. General information

NPI: 1992694590
Provider Name (Legal Business Name): HEALING AT THE WELL WOMEN MENTORSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 KRAMER ST APT 3D
STATEN ISLAND NY
10305-2546
US

IV. Provider business mailing address

132 KRAMER ST APT 3D
STATEN ISLAND NY
10305-2546
US

V. Phone/Fax

Practice location:
  • Phone: 929-431-4764
  • Fax:
Mailing address:
  • Phone: 929-431-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MRS. FRANCES KELLMAN
Title or Position: LIFE COACH/MENTOR
Credential:
Phone: 929-431-4764