NPIMap

Organization Active NPI

Waterlily Wellness, LLC

  • Clinic/Center
  • Medford, MA
National Provider Identifier
1063268639
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WATERLILY WELLNESS, LLC
Practice address
0 Governors Ave Ste 2
Medford, MA 02155-3037
Phone
(179) 028-7696
Fax
(617) 977-9728
NPI assigned
Apr 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kathia Kirschner, LIC. AC.NPI 1104260678
Title
Owner
Phone
(617) 902-8769

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

0 Governors Ave Ste 2
Medford, MA 02155-3037

Mailing address

0 Governors Ave Ste 2
Medford, MA 02155-3037
Phone (179) 028-7696

Other names 1

  • Waterlily Wellness Doing business as

National Provider Directory

National Provider Directory

Locations

0 Governors Ave
Ste 2
Medford, MA 02155
Phone (617) 902-8769

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1063268639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "0 GOVERNORS AVE STE 2",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553037",
            "telephone_number": "179-028-7696",
            "fax_number": "617-977-9728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "0 GOVERNORS AVE STE 2",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553037",
            "telephone_number": "179-028-7696",
            "fax_number": "617-977-9728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERLILY WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "KIRSCHNER",
        "authorized_official_first_name": "KATHIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-902-8769",
        "authorized_official_credential": "LIC. AC."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterlily Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.