Healthcare Provider Details

I. General information

NPI: 1477462422
Provider Name (Legal Business Name): MEGAN GRACE HOLLISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 EASTERN BLVD STE 200
GLASTONBURY CT
06033-4321
US

IV. Provider business mailing address

99 HIGHLAND VIEW DR
SOMERS CT
06071-1557
US

V. Phone/Fax

Practice location:
  • Phone: 860-815-8991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12362
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: