NPIMap

Organization Active NPI

Amber Moon Wellness, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portsmouth, NH
National Provider Identifier
1689329112
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
AMBER MOON WELLNESS, PLLC
Practice address
426 State St
Portsmouth, NH 03801-4049
Phone
(707) 654-4325
Fax
(630) 883-0690
NPI assigned
Feb 14, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Authorized official

Name
Mrs. Kathleen Amanda Waleryszak, LICSWNPI 1821647470
Title
Owner
Phone
(707) 654-4325

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

426 State St
Portsmouth, NH 03801-4049

Mailing address

8A Ridgewood Dr
Kittery, ME 03904-1046
Phone (207) 337-0456

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@ambermoonwellness.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220224000253 NH Part B Supplier - Clinic/Group Practice 8820482482 Receives reassigned benefits from 1 practitioner
Practice locations: Portsmouth, NH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1644796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644796800000",
    "number": "1689329112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8A RIDGEWOOD DR",
            "city": "KITTERY",
            "state": "ME",
            "postal_code": "039041046",
            "telephone_number": "207-337-0456",
            "fax_number": "630-883-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 STATE ST",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038014049",
            "telephone_number": "707-654-4325",
            "fax_number": "630-883-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBER MOON WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A",
        "authorized_official_last_name": "WALERYSZAK",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-654-4325",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@ambermoonwellness.com",
            "affiliation": "N",
            "endpointDescription": "Business URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "426 State St",
            "city": "Portsmouth",
            "state": "NH",
            "country_code": "US",
            "postal_code": "038014049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portsmouth, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.