Healthcare Provider Details

I. General information

NPI: 1306564976
Provider Name (Legal Business Name): PEACE CONNECTION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ROOSEVELT AVE STE 2
MYSTIC CT
06355-2832
US

IV. Provider business mailing address

11 BOSTON POST RD FL 2
WATERFORD CT
06385-2401
US

V. Phone/Fax

Practice location:
  • Phone: 860-485-7992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEANNINE CLEAVER
Title or Position: OWNER
Credential: LCSW
Phone: 860-245-9840