Provider Demographics
NPI:1760219513
Name:FRONTLINE WELLNESS GROUP
Entity type:Organization
Organization Name:FRONTLINE WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-764-3324
Mailing Address - Street 1:5 SURFSIDE RD
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6033
Mailing Address - Country:US
Mailing Address - Phone:917-764-3324
Mailing Address - Fax:
Practice Address - Street 1:242 MAIN ST # 228
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2732
Practice Address - Country:US
Practice Address - Phone:917-764-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty