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General NPI Number Information
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NPI Number | 1316667207
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Entity Type | Organization
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Legal Business Name | SYNRISE WELLNESS LLC
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 11/13/2022
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Provider Practice Location Address
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Address Line | 65 WALDEN ST
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City | CAMBRIDGE
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State | MA
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Zip | 02140-3325
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Country | US
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Telephone | 617-297-7791
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Fax |
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Provider Business Mailing Address
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Address Line | 165 MIDDLESEX AVE # 1089
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City | SOMERVILLE
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State | MA
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Zip | 02145-1105
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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 | OWNER
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Name | YUN WANG
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Credential | PSYD
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Telephone | 617-297-7791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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