Provider Demographics
NPI:1225704885
Name:NEW ENGLAND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:NEW ENGLAND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-852-1566
Mailing Address - Street 1:180 WESTBROOK RD #3
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1517
Mailing Address - Country:US
Mailing Address - Phone:860-800-2770
Mailing Address - Fax:860-852-1560
Practice Address - Street 1:180 WESTBROOK RD
Practice Address - Street 2:#3
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1501
Practice Address - Country:US
Practice Address - Phone:860-800-2770
Practice Address - Fax:860-852-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty