Healthcare Provider Details

I. General information

NPI: 1992360143
Provider Name (Legal Business Name): NEW ROAD WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MICHAEL DR
CLINTON CT
06413-1068
US

IV. Provider business mailing address

24 W MAIN ST STE 357
CLINTON CT
06413-2053
US

V. Phone/Fax

Practice location:
  • Phone: 203-318-6484
  • Fax: 203-318-6484
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THERESA LAGGIS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 860-227-5725