Basic Information
| Provider Information | |||||||||
| NPI: | 1689243305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESTORATIVE HEALTH AND WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N MAIN ST STE 8 | ||||||||
| Address2: | |||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010282354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6046177928 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 N MAIN ST STE 8 | ||||||||
| Address2: | |||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010282354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604617792 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | SHALONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | FOUNDER, CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4132376950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.