Healthcare Provider Details

I. General information

NPI: 1104748649
Provider Name (Legal Business Name): NEW LIFE INTEGRATED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JEM WOODS RD
OXFORD CT
06478-1594
US

IV. Provider business mailing address

35 JEM WOODS RD
OXFORD CT
06478-1594
US

V. Phone/Fax

Practice location:
  • Phone: 203-951-1858
  • Fax: 203-951-1857
Mailing address:
  • Phone: 203-951-1858
  • Fax: 203-951-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W ALLEN
Title or Position: CEO
Credential:
Phone: 203-856-3936