Provider Demographics
NPI:1871391169
Name:LAVENDER ST HEALTH & WELLNESS
Entity type:Organization
Organization Name:LAVENDER ST HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:774-901-4949
Mailing Address - Street 1:61 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-1966
Mailing Address - Country:US
Mailing Address - Phone:774-901-4949
Mailing Address - Fax:774-901-4949
Practice Address - Street 1:16 LAVENDER ST HEALTH &WELLNESS
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054
Practice Address - Country:US
Practice Address - Phone:774-901-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty