Healthcare Provider Details

I. General information

NPI: 1518569375
Provider Name (Legal Business Name): INNER YOU CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 JEROME AVE STE 106
BLOOMFIELD CT
06002-2463
US

IV. Provider business mailing address

325 DUNFEY LN
WINDSOR CT
06095-2314
US

V. Phone/Fax

Practice location:
  • Phone: 860-952-3335
  • Fax:
Mailing address:
  • Phone: 860-952-3335
  • Fax:

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: DANIELLE TURNER
Title or Position: OWNER
Credential: LCSW
Phone: 860-952-3335