Healthcare Provider Details

I. General information

NPI: 1386279453
Provider Name (Legal Business Name): PATHWAYS TO WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 11/27/2023
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 SHELDON TER
NEW HAVEN CT
06511-2006
US

IV. Provider business mailing address

185 CANAL ST UNIT 1003
SHELTON CT
06484-8122
US

V. Phone/Fax

Practice location:
  • Phone: 203-941-1884
  • Fax: 203-712-7718
Mailing address:
  • Phone: 203-941-1884
  • Fax: 203-712-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISE MICHELLE NEWTON
Title or Position: CO-OWNER/PSCYHOTHERAPIST
Credential: LCSW
Phone: 203-941-1884