=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255203667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERWELL HEALTH GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82 WENDELL AVE STE 100
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-7066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-789-0808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 82 WENDELL AVE STE 100
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-7066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-789-0808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURIE BOTIE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 617-789-0808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207QA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------