MEDICARE: WORTHY OF WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	133VN1004X	Pediatric Nutrition Registered Dietitian
2	133VN1005X	Renal Nutrition Registered Dietitian
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker
5	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1033052642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORTHY OF WELLNESS LLC

Provider Business Mailing Address
First Line	:	12518 QUEENS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1503
Country	:	US
Telephone Number	:	347-885-7102
Fax Number	:

Provider Business Practice Location Address
First Line	:	12518 QUEENS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1503
Country	:	US
Telephone Number	:	347-885-7102
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JESSICA VILLALVIR
Credential	:	MS RDN CDN LDN
Telephone Number	:	347-885-7102

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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