Healthcare Provider Details

I. General information

NPI: 1992161681
Provider Name (Legal Business Name): A HEALTHY MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MIGEON AVE
TORRINGTON CT
06790-4861
US

IV. Provider business mailing address

PO BOX 1233
TORRINGTON CT
06790-1233
US

V. Phone/Fax

Practice location:
  • Phone: 860-459-1134
  • Fax:
Mailing address:
  • Phone: 860-459-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2634
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007548
License Number StateCT

VIII. Authorized Official

Name: MS. RUTH L SIMONCELLI
Title or Position: OWNER
Credential: L.P.C
Phone: 860-459-1134