Provider Demographics
NPI:1770935314
Name:ESSENTIAL WELLNESS PLC
Entity type:Organization
Organization Name:ESSENTIAL WELLNESS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-558-5656
Mailing Address - Street 1:1151 NW HILL RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:VT
Mailing Address - Zip Code:05261-9448
Mailing Address - Country:US
Mailing Address - Phone:802-558-5656
Mailing Address - Fax:
Practice Address - Street 1:339 DEWEY ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2253
Practice Address - Country:US
Practice Address - Phone:802-445-3039
Practice Address - Fax:802-445-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1652Medicaid