Healthcare Provider Details

I. General information

NPI: 1801704614
Provider Name (Legal Business Name): MICHELLE GASTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GOOSE LN
TOLLAND CT
06084-3417
US

IV. Provider business mailing address

44 SCOTT DR
MANCHESTER CT
06042-2359
US

V. Phone/Fax

Practice location:
  • Phone: 860-454-0520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GASTON
Title or Position: MEMBER
Credential:
Phone: 860-324-0861