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General NPI Number Information
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NPI Number | 1215528641
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Entity Type | Organization
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Legal Business Name | NORTHEAST WELLNESS, LLC
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Dates
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Enumeration Date | 01/28/2021
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 22 MILL ST STE 108
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City | ARLINGTON
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State | MA
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Zip | 02476-4738
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Country | US
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Telephone | 617-848-4417
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Fax | 617-848-4417
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Provider Business Mailing Address
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Address Line | 71 COMMERCIAL ST # 166
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City | BOSTON
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State | MA
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Zip | 02109-1320
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Country | US
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Telephone | 617-848-4417
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATION OFFICER
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Name | AMANDEEP KAUR
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Credential |
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Telephone | 781-469-5320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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