Healthcare Provider Details

I. General information

NPI: 1568384808
Provider Name (Legal Business Name): WOMB TO MOON FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 DONATA LN
STAMFORD CT
06905-1908
US

IV. Provider business mailing address

36 DONATA LN
STAMFORD CT
06905-1908
US

V. Phone/Fax

Practice location:
  • Phone: 203-501-2070
  • Fax:
Mailing address:
  • Phone: 203-501-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: BETHANY COLLEY
Title or Position: MANAGING MEMBER
Credential: CERTIFIED DOULA
Phone: 203-501-2070