Healthcare Provider Details

I. General information

NPI: 1053982850
Provider Name (Legal Business Name): KALEIDOSCOPE GROWTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WOODSIDE CIR
TORRINGTON CT
06790-2239
US

IV. Provider business mailing address

101 WOODSIDE CIR
TORRINGTON CT
06790-2239
US

V. Phone/Fax

Practice location:
  • Phone: 860-483-8529
  • Fax:
Mailing address:
  • Phone: 860-483-8529
  • 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: CHRISTINA BOREL
Title or Position: FOUNDER
Credential:
Phone: 617-529-8513