Healthcare Provider Details

I. General information

NPI: 1093191637
Provider Name (Legal Business Name): THE HOPE CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HALLS RD SUITE 203
OLD LYME CT
06371-4409
US

IV. Provider business mailing address

PO BOX 579
OLD LYME CT
06371-0579
US

V. Phone/Fax

Practice location:
  • Phone: 860-598-0111
  • Fax:
Mailing address:
  • Phone: 860-598-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008134
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. KAREN BUROFF
Title or Position: OWNER
Credential: LCSW
Phone: 860-227-5805