=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972314490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART & HARMONY HOLISTIC HEALING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2025
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1645 WARWICK AVE STE 203
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02889-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-615-4247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 76 EDISON ST
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02889-1536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-615-4247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KIMBERLY PELLETIER
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 401-615-4247
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------