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General NPI Number Information
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NPI Number | 1548882582
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Entity Type | Organization
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Legal Business Name | EWELLNESS THERAPY, PLLC
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 6365 COLLINS AVE APT 2501
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City | MIAMI BEACH
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State | FL
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Zip | 33141-9617
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Country | US
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Telephone | 802-734-5285
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Fax |
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Provider Business Mailing Address
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Address Line | 6365 COLLINS AVE APT 2501
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City | MIAMI BEACH
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State | FL
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Zip | 33141-9617
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Country | US
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Telephone | 802-734-5285
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEVEN BREAKSTONE
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Credential |
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Telephone | 802-734-5285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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