Healthcare Provider Details

I. General information

NPI: 1770412215
Provider Name (Legal Business Name): LET GO WELLNESS PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 HIGHLAND AVE
WATERBURY CT
06708-4626
US

IV. Provider business mailing address

808 HIGHLAND AVE
WATERBURY CT
06708-4626
US

V. Phone/Fax

Practice location:
  • Phone: 203-217-3530
  • Fax:
Mailing address:
  • Phone: 203-217-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: WALESKA CASTILLO
Title or Position: OWNER
Credential: LPC
Phone: 203-217-3530