Healthcare Provider Details

I. General information

NPI: 1487567426
Provider Name (Legal Business Name): YOGA4CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 CROWN ST FL 2
NEW HAVEN CT
06510-2705
US

IV. Provider business mailing address

216 CROWN ST FL 2
NEW HAVEN CT
06510-2705
US

V. Phone/Fax

Practice location:
  • Phone: 203-645-4933
  • Fax:
Mailing address:
  • Phone: 203-645-4933
  • 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: TROY PAPA
Title or Position: BOOKKEEPER
Credential:
Phone: 941-780-1178