Healthcare Provider Details

I. General information

NPI: 1710452255
Provider Name (Legal Business Name): CT KIDS MATTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 HIGHLAND AVE STE 102
CHESHIRE CT
06410-2550
US

IV. Provider business mailing address

345 HIGHLAND AVE STE 102
CHESHIRE CT
06410-2550
US

V. Phone/Fax

Practice location:
  • Phone: 203-599-1492
  • Fax:
Mailing address:
  • Phone: 203-599-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATHER R LASELLE
Title or Position: EXECUTIVE CLINICAL DIRECTOR
Credential: PHD, LCSW,MS,MPA
Phone: 203-599-1492