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General NPI Number Information
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NPI Number | 1558270207
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Entity Type | Organization
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Legal Business Name | NORTHLINE WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 09/07/2026
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Last Update Date | 09/07/2026
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Provider Practice Location Address
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Address Line | 163 HIGHLAND AVE # 1268
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City | NEEDHAM HEIGHTS
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State | MA
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Zip | 02494-3025
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Country | US
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Telephone | 540-429-1903
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Fax |
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Provider Business Mailing Address
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Address Line | 163 HIGHLAND AVE # 1268
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City | NEEDHAM HEIGHTS
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State | MA
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Zip | 02494-3025
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Country | US
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Telephone | 540-429-1903
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Fax |
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Authorized Official
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Title or Position | OWNER/PMHNP-BC
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Name | BEATRICE A AZAH
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Credential | PMHNP-BC
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Telephone | 540-429-1903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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