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General NPI Number Information
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NPI Number | 1225710734
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Entity Type | Organization
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Legal Business Name | WILLOW WELLNESS PLLC
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 2 GRANITE AVE STE 260
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City | MILTON
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State | MA
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Zip | 02186-4381
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Country | US
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Telephone | 617-315-4868
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Fax |
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Provider Business Mailing Address
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Address Line | 288 GROVE ST # 334
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City | BRAINTREE
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State | MA
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Zip | 02184-7209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PRIYA MARIE HIPPOLYTE
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Credential | PMHNP-BC
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Telephone | 617-315-4868
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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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