Organization
EVERGREEN WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBECCA NILI UTH PSYD (MANAGER)
(508) 386-2094
Entity
Organization
Contact information
Practice address
171 HIGHLAND ST APT 303, TAUNTON, MA 02780-4446
(508) 386-2094
(508) 967-7194
Mailing address
PO BOX 767, WEST WARWICK, RI 02893-0610
(508) 386-2094
(508) 967-7194
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
104100000X
Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110165840A
—
MA
Enumeration date
08/11/2020
Last updated
05/24/2022
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