Healthcare Provider Details

I. General information

NPI: 1902768708
Provider Name (Legal Business Name): THRIVING LIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOANK LEDYARD RD STE 15
MYSTIC CT
06355-1361
US

IV. Provider business mailing address

1101 NOANK LEDYARD RD STE 15
MYSTIC CT
06355-1361
US

V. Phone/Fax

Practice location:
  • Phone: 860-980-6163
  • Fax:
Mailing address:
  • Phone: 860-980-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KRISTA SCHERMERHORN BORDELEAU
Title or Position: OWNER
Credential: LBA, BCBA
Phone: 860-980-6163