Healthcare Provider Details

I. General information

NPI: 1982132718
Provider Name (Legal Business Name): SUPPORT THROUGHOUT THE JOURNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 MONROE TPKE UNIT B
MONROE CT
06468-6200
US

IV. Provider business mailing address

775 CHICKADEE LN
STRATFORD CT
06614-2479
US

V. Phone/Fax

Practice location:
  • Phone: 203-414-5393
  • Fax:
Mailing address:
  • Phone: 203-414-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA A MONTELLI-CAVOTO
Title or Position: LCSW
Credential: LCSW
Phone: 203-414-5393