Provider Demographics
NPI:1427738624
Name:INTEGRATIVE PSYCHIATRY & WELLNESS CO.
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHIATRY & WELLNESS CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:508-964-3330
Mailing Address - Street 1:155 SOUTH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1596
Mailing Address - Country:US
Mailing Address - Phone:508-964-3330
Mailing Address - Fax:
Practice Address - Street 1:155 SOUTH ST STE 101
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1596
Practice Address - Country:US
Practice Address - Phone:508-964-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty