=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043071186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GATEWAY TO WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2024
-----------------------------------------------------
Last Update Date | 01/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CARVER SQUARE BLVD
-----------------------------------------------------
City | CARVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02330-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-667-0020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 591
-----------------------------------------------------
City | WEST WAREHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02576-0591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-404-4896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. VERONICA CHRISTINA LEE
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 774-404-4896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------