=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780452516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UDDINA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2023
-----------------------------------------------------
Last Update Date | 12/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 KAYA GUZMANBLANCU
-----------------------------------------------------
City | WILLEMSTAD
-----------------------------------------------------
State | CURACAO
-----------------------------------------------------
Zip | 00000
-----------------------------------------------------
Country | AN
-----------------------------------------------------
Telephone | 508-648-2299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6052
-----------------------------------------------------
City | GLOUCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01930-4752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-648-2299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | SHRUTI TEKWANI
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 508-648-2299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------