Healthcare Provider Details

I. General information

NPI: 1104619980
Provider Name (Legal Business Name): HEAL & GROW THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FERNWOOD RD
TRUMBULL CT
06611-2803
US

IV. Provider business mailing address

177 FERNWOOD RD
TRUMBULL CT
06611-2803
US

V. Phone/Fax

Practice location:
  • Phone: 203-873-7310
  • Fax: 203-873-7310
Mailing address:
  • Phone: 203-923-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIRLEY C SANTANA
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 203-923-3601