Healthcare Provider Details

I. General information

NPI: 1962601740
Provider Name (Legal Business Name): THE LIFE CENTER OF CT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-17-19 MAY STREET
HARTFORD CT
06105-1519
US

IV. Provider business mailing address

15-17 MAY STREET
HARTFORD CT
06105-1519
US

V. Phone/Fax

Practice location:
  • Phone: 860-728-5199
  • Fax: 860-524-0418
Mailing address:
  • Phone: 860-728-5199
  • Fax: 860-524-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSA0065
License Number StateCT

VIII. Authorized Official

Name: ESTHER GONZALEZ-TORRES
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 860-209-1562