Healthcare Provider Details

I. General information

NPI: 1982194585
Provider Name (Legal Business Name): WELLNESS AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 ENO AVE
TORRINGTON CT
06790
US

IV. Provider business mailing address

PAULINE MILLER, MSW, LCSW 254 ENO AVENUE
TORRINGTON CT
06790
US

V. Phone/Fax

Practice location:
  • Phone: 860-605-4855
  • Fax:
Mailing address:
  • Phone: 860-605-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004046
License Number StateCT

VIII. Authorized Official

Name: PAULINE A MILLER
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 860-605-4855