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General NPI Number Information
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NPI Number | 1306630199
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Entity Type | Organization
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Legal Business Name | HEALING THE WOUNDED SOUL LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 16 DAKIN AVE STE 110
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City | MOUNT KISCO
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State | NY
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Zip | 10549-2826
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Country | US
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Telephone | 516-225-8767
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Fax |
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Provider Business Mailing Address
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Address Line | 644 GREAT RD
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City | NORTH SMITHFIELD
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State | RI
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Zip | 02896-6864
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Country | US
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Telephone | 401-533-6245
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Fax | 401-424-4531
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Authorized Official
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Title or Position | CREDENTIALING/BILLING MANAGER
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Name | KRISTEN DUCHARME
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Credential |
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Telephone | 401-533-6245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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