Provider Demographics
NPI:1871328476
Name:PSYCHIATRY AT THE WELL LLC
Entity type:Organization
Organization Name:PSYCHIATRY AT THE WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, FNP
Authorized Official - Phone:781-789-8274
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:MA
Mailing Address - Zip Code:02338-0364
Mailing Address - Country:US
Mailing Address - Phone:781-789-8274
Mailing Address - Fax:
Practice Address - Street 1:1029 PLEASANT ST STE 101
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2473
Practice Address - Country:US
Practice Address - Phone:781-789-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health