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General NPI Number Information
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NPI Number | 1811761364
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Entity Type | Organization
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Legal Business Name | HYDRO HEAL LLC
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Dates
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Enumeration Date | 11/14/2023
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 273 RIDGE LN APT 308
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City | WALTHAM
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State | MA
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Zip | 02452-4990
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Country | US
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Telephone | 857-316-8020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 541378
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City | WALTHAM
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State | MA
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Zip | 02454-1378
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Country | US
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Telephone | 857-316-8020
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PEARL ALWENY
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Credential | NP
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Telephone | 857-316-8020
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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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