Provider Demographics
NPI:1720674773
Name:MIND. BODY. POWHER
Entity type:Organization
Organization Name:MIND. BODY. POWHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALVES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:774-260-6437
Mailing Address - Street 1:22 WEST ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2677
Mailing Address - Country:US
Mailing Address - Phone:774-260-6437
Mailing Address - Fax:
Practice Address - Street 1:22 WEST ST STE 4A
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2677
Practice Address - Country:US
Practice Address - Phone:774-260-6437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty