NPIMap

Organization Active NPI

Revive Wellness

  • Community/Behavioral Health Agency
  • Conshohocken, PA
National Provider Identifier
1912443094
Registry record updated May 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
CW016642 Issued in PA
Legal business name
REVIVE WELLNESS
Practice address
119 Harry St
First Floor
Conshohocken, PA 19428
Phone
(610) 457-8542
NPI assigned
Jan 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2017

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

Authorized official

Name
Leiza Stanley, LCSWNPI 1215241757
Title
Owner
Phone
(640) 457-8542

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X CW016642 PA Primary

Addresses

Primary practice location

119 Harry St
First Floor
Conshohocken, PA 19428

Mailing address

119 Harry Street
Conshohocken, PA 19428

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1912443094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 HARRY STREET",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "19428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 HARRY ST",
            "address_2": "FIRST FLOOR",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "19428",
            "telephone_number": "610-457-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-12",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "LEIZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "640-457-8542",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "CW016642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conshohocken, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; 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.