MEDICARE: LEARNING TO LIVE LIFE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	000695	CT

General Provider Information

NPI Number	:	1194130112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEARNING TO LIVE LIFE, LLC

Provider Business Mailing Address
First Line	:	182 GRAND ST
Second Line	:	SUITE 420-422
City	:	WATERBURY
State	:	CT
Zip	:	06702-1914
Country	:	US
Telephone Number	:	203-528-3054
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 GRAND ST
Second Line	:	SUITE 420-422
City	:	WATERBURY
State	:	CT
Zip	:	06702-1914
Country	:	US
Telephone Number	:	203-528-3054
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	CLARISSA GARNETT
Credential	:	LADC
Telephone Number	:	860-883-7062

Provider Enumeration Date	:	06/28/2014
Last Update Date	:	06/28/2014

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