Healthcare Provider Details

I. General information

NPI: 1629769591
Provider Name (Legal Business Name): BEWELL THERAPY COLLABORATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 TIOGUE AVE UNIT 2
COVENTRY RI
02816-6114
US

IV. Provider business mailing address

1060 TIOGUE AVE UNIT 2
COVENTRY RI
02816-6114
US

V. Phone/Fax

Practice location:
  • Phone: 401-250-4174
  • Fax:
Mailing address:
  • Phone: 401-250-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RICHELLE DOWELL
Title or Position: OWNER
Credential: LICSW
Phone: 401-250-4174