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General NPI Number Information
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NPI Number | 1619400652
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Entity Type | Organization
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Legal Business Name | WELLNESS WITHIN LLC
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 200 N MAIN ST SUITE 11
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-2392
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Country | US
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Telephone | 413-209-7796
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Fax | 413-200-3095
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Provider Business Mailing Address
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Address Line | 200 N MAIN ST SUITE 11
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-2392
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Country | US
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Telephone | 413-209-7796
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Fax | 413-200-3095
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | HEATHER GAUDETTE
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Credential | MSW, LICSW
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Telephone | 732-309-9016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 119011
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License Number State | MA
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