Healthcare Provider Details

I. General information

NPI: 1376475350
Provider Name (Legal Business Name): FRONTLINE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HALLS RD STE 202
OLD LYME CT
06371-4409
US

IV. Provider business mailing address

83 HALLS RD STE 202
OLD LYME CT
06371-4409
US

V. Phone/Fax

Practice location:
  • Phone: 860-373-7024
  • Fax:
Mailing address:
  • Phone: 860-373-7024
  • 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: MADISON BODLEY
Title or Position: BUSINESS OWNEER
Credential:
Phone: 860-597-4553