Healthcare Provider Details

I. General information

NPI: 1649607201
Provider Name (Legal Business Name): INNER CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 LEBANON RD
BOZRAH CT
06334-1116
US

IV. Provider business mailing address

44 LEBANON RD
BOZRAH CT
06334-1116
US

V. Phone/Fax

Practice location:
  • Phone: 860-416-3814
  • Fax:
Mailing address:
  • Phone: 860-416-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001495
License Number StateCT

VIII. Authorized Official

Name: CARLA S RICCI
Title or Position: LMFT
Credential: LMFT
Phone: 860-416-3814