Evergreen Wellness Center, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

EVERGREEN WELLNESS CENTER, LLC

Practice address

171 Highland St Apt 303
Taunton, MA 02780-4446

Phone

(508) 386-2094

Fax

(508) 967-7194

NPI assigned

Aug 11, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Rebecca Nili Uth, PSYDNPI 1669923975

Title

Manager

Phone

(508) 386-2094

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in RI, MA2 enrollments

Enrollment records 2

Locations

Practitioners 3

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

• Rebecca Uth, PSYD

  • Clinical Psychologist
  • Taunton, MA
  • NPI 1669923975
  Medicare reassignment Authorized official
• Christina Mei-Chia Fucci, PSY.D

  • Clinical Psychologist
  • Warwick, RI
  • NPI 1487987863
  Medicare reassignment NPD
• Brendan Michael McCarthy

  • Clinical Social Worker
  • West Warwick, RI
  • NPI 1841015880
  NPD

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1467063875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767",
            "city": "WEST WARWICK",
            "state": "RI",
            "postal_code": "028930610",
            "telephone_number": "508-386-2094",
            "fax_number": "508-967-7194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 HIGHLAND ST APT 303",
            "city": "TAUNTON",
            "state": "MA",
            "postal_code": "027804446",
            "telephone_number": "508-386-2094",
            "fax_number": "508-967-7194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Washington St Unit 767",
            "address_purpose": "LOCATION",
            "city": "West Warwick",
            "state": "RI",
            "postal_code": "028937749",
            "country_code": "US",
            "telephone_number": "508-386-2094",
            "fax_number": "508-967-7194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-11",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "UTH",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "NILI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "508-386-2094",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110165840A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Taunton, MA
• Providers in Taunton, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.