Provider Demographics
NPI:1306458542
Name:RESTORATIVE WELLNESS
Entity type:Organization
Organization Name:RESTORATIVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-749-4991
Mailing Address - Street 1:16 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4115
Mailing Address - Country:US
Mailing Address - Phone:207-749-4991
Mailing Address - Fax:
Practice Address - Street 1:16 DEPOT ST
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4115
Practice Address - Country:US
Practice Address - Phone:207-749-4991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty