Healthcare Provider Details

I. General information

NPI: 1083095988
Provider Name (Legal Business Name): PSYCHOTHERAPY HEALING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BARNARD LN SUITE 310
BLOOMFIELD CT
06002-2452
US

IV. Provider business mailing address

3 BARNARD LN SUITE 310
BLOOMFIELD CT
06002-2452
US

V. Phone/Fax

Practice location:
  • Phone: 860-586-8700
  • Fax: 860-236-1909
Mailing address:
  • Phone: 860-586-8700
  • Fax: 860-236-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CELESTE E MATTINGLY
Title or Position: LCSW
Credential:
Phone: 718-841-7392