Healthcare Provider Details

I. General information

NPI: 1407421522
Provider Name (Legal Business Name): EMPATHIC HEARTS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MAGNOLIA DRIVE
ENFIELD CT
06082-2016
US

IV. Provider business mailing address

16 MAGNOLIA DRIVE
ENFIELD CT
06082-2016
US

V. Phone/Fax

Practice location:
  • Phone: 860-977-0769
  • Fax:
Mailing address:
  • Phone: 860-977-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JANICE LEPAGE
Title or Position: SOLE PROPRIETOR/THERAPIST
Credential:
Phone: 860-977-0769