MEDICARE: EWELLNESS THERAPY, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548882582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EWELLNESS THERAPY, PLLC

Provider Business Mailing Address
First Line	:	6365 COLLINS AVE APT 2501
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-9617
Country	:	US
Telephone Number	:	802-734-5285
Fax Number	:

Provider Business Practice Location Address
First Line	:	6365 COLLINS AVE APT 2501
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-9617
Country	:	US
Telephone Number	:	802-734-5285
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	STEVEN BREAKSTONE
Credential	:
Telephone Number	:	802-734-5285

Provider Enumeration Date	:	05/13/2020
Last Update Date	:	11/10/2023

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