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General NPI Number Information
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NPI Number | 1013428721
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Entity Type | Organization
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Legal Business Name | EVOLVE INTERNAL WELLNESS AND COUNSELING, LLC
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 14 HAVEN ROAD
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City | WELLESLEY
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State | MA
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Zip | 02481
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Country | US
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Telephone | 603-455-2428
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Fax | 617-706-2603
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Provider Business Mailing Address
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Address Line | 14 HAVEN ROAD
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City | WELLESLEY
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State | MA
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Zip | 02481
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Country | US
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Telephone | 603-455-2428
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Fax | 617-706-2603
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Authorized Official
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Title or Position | LICS, THERAPIST AND OWNER OF EVOLVE
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Name | JESSICA CALANTHA CARREIRO
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Credential | LICSW
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Telephone | 603-455-2428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117142
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License Number State | MA
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