Healthcare Provider Details

I. General information

NPI: 1992465785
Provider Name (Legal Business Name): ASTACIO WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 HIGHLAND AVE
TORRINGTON CT
06790-4751
US

IV. Provider business mailing address

330 HIGHLAND AVE APT 7I
TORRINGTON CT
06790-4727
US

V. Phone/Fax

Practice location:
  • Phone: 860-309-5644
  • Fax:
Mailing address:
  • Phone: 860-309-5644
  • 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: STARLIN ASTACIO
Title or Position: PSYCHOTHERAPIST
Credential: LMFT
Phone: 860-309-5644