Healthcare Provider Details

I. General information

NPI: 1649095696
Provider Name (Legal Business Name): INFLORESCENCE HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CEDAR ST STE 208
NEWINGTON CT
06111-2655
US

IV. Provider business mailing address

229 GOODALE DR
NEWINGTON CT
06111-3124
US

V. Phone/Fax

Practice location:
  • Phone: 860-577-2127
  • Fax:
Mailing address:
  • Phone: 860-577-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNA ROSE ALCARAZ
Title or Position: MEMBER
Credential:
Phone: 860-577-2127