Healthcare Provider Details

I. General information

NPI: 1003387705
Provider Name (Legal Business Name): HEALTHY HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 DOBBS FERRY RD STE 200
WHITE PLAINS NY
10607-1908
US

IV. Provider business mailing address

280 DOBBS FERRY RD STE 200
WHITE PLAINS NY
10607-1908
US

V. Phone/Fax

Practice location:
  • Phone: 914-830-4849
  • Fax:
Mailing address:
  • Phone: 914-830-4849
  • Fax: 914-885-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KISMYTH SHULER
Title or Position: CEO/OWNER
Credential: LCSW
Phone: 914-830-4849