Provider Demographics
NPI:1528730314
Name:KINTSUGI CENTER FOR HEALING AND WHOLENESS, LLC
Entity type:Organization
Organization Name:KINTSUGI CENTER FOR HEALING AND WHOLENESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-641-1342
Mailing Address - Street 1:91 MAIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-4437
Mailing Address - Country:US
Mailing Address - Phone:508-343-0379
Mailing Address - Fax:
Practice Address - Street 1:91 MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-4437
Practice Address - Country:US
Practice Address - Phone:508-343-0379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAREN OLIVEIRA, LICSW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-30
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)