Healthcare Provider Details

I. General information

NPI: 1407787765
Provider Name (Legal Business Name): WHOLENESS INSIGHT PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAIN ST UNIT 11-3G
MYSTIC CT
06355-3654
US

IV. Provider business mailing address

655 LONG COVE RD
GALES FERRY CT
06335-2007
US

V. Phone/Fax

Practice location:
  • Phone: 860-800-3412
  • Fax:
Mailing address:
  • Phone: 860-800-3412
  • 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: DANIEL BROWN
Title or Position: OWNER
Credential: LCSW
Phone: 860-800-3412