MEDICARE: LIFE COACHING AND THERAPY 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	251S00000X	Community/Behavioral Health Agency
2	251S00000X	Community/Behavioral Health Agency	001556	CT

General Provider Information

NPI Number	:	1720400831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE COACHING AND THERAPY LLC

Provider Business Mailing Address
First Line	:	801 FARMINGTON AVE STE 2C
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1672
Country	:	US
Telephone Number	:	203-733-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	944 NEW BRITAIN AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2228
Country	:	US
Telephone Number	:	203-733-9600
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND CLINICIAN
Name	:	DR. AMANDA PASCIUCCO
Credential	:	PHD, LMFT, AASECTCST
Telephone Number	:	203-733-9600

Provider Enumeration Date	:	01/08/2014
Last Update Date	:	08/03/2023

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