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General NPI Number Information
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NPI Number | 1770309098
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Entity Type | Organization
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Legal Business Name | MIND AND HEART WORKSHOP GROUP LLC
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 151 EVERETT AVE
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City | CHELSEA
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State | MA
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Zip | 02150-1812
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Country | US
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Telephone | 617-887-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 417 MAIN ST UNIT 1
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City | EVERETT
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State | MA
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Zip | 02149-5729
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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 | PSYCHOTHERAPIST
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Name | A G AVILA
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Credential | LICSW, MPH
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Telephone | 617-887-3809
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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 |
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License Number State |
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