Provider Demographics
NPI:1104537646
Name:BALSAM LOTUS HEALING AND WELLNESS
Entity type:Organization
Organization Name:BALSAM LOTUS HEALING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, FOUNDER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULET-ALMEIDA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-541-5989
Mailing Address - Street 1:63 SOCKANOSSET CROSS RD STE 63C
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:63 SOCKANOSSET CROSS RD STE 63C
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5557
Practice Address - Country:US
Practice Address - Phone:401-541-5989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI854003564Medicaid