MEDICARE: NOURISHED PEACE THERAPY, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1851280523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISHED PEACE THERAPY, LLC

Provider Business Mailing Address
First Line	:	40 PITTROFF AVE
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-2246
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 PITTROFF AVE
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-2246
Country	:	US
Telephone Number	:	413-200-9002
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTIN PHELAN
Credential	:	LICSW
Telephone Number	:	413-200-9002

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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