Healthcare Provider Details

I. General information

NPI: 1376329797
Provider Name (Legal Business Name): SKYWARD THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 ELM ST STE 203
ENFIELD CT
06082-3739
US

IV. Provider business mailing address

113 ELM ST STE 203
ENFIELD CT
06082-3739
US

V. Phone/Fax

Practice location:
  • Phone: 860-239-0667
  • Fax: 860-239-0659
Mailing address:
  • Phone: 860-239-0667
  • Fax: 860-239-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA MICHAEL EDWARDS
Title or Position: OWNER
Credential: PHD, LPC, RPT, NCC
Phone: 860-265-9101