Healthcare Provider Details

I. General information

NPI: 1104221019
Provider Name (Legal Business Name): HOLISTIC PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BOSTON ST.
GUILFORD CT
06437
US

IV. Provider business mailing address

198 ANNS FARM RD.
HAMDEN CT
06518
US

V. Phone/Fax

Practice location:
  • Phone: 973-960-9672
  • Fax:
Mailing address:
  • Phone: 973-960-9672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002022
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8811
License Number StateCT

VIII. Authorized Official

Name: JANINA TAURO
Title or Position: CLINICIAN
Credential: LCSW
Phone: 973-960-9672