=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750027249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCH WELLNESS GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2022
-----------------------------------------------------
Last Update Date | 05/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 SUSAN DR
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-454-5949
-----------------------------------------------------
Fax | 413-642-6078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 771 BOSTON POST RD E STE 11
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752-3759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-454-5949
-----------------------------------------------------
Fax | 413-642-6078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. NANCY R VETO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 413-454-5949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------