Healthcare Provider Details

I. General information

NPI: 1114863834
Provider Name (Legal Business Name): MOXIE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 VAUXHALL STREET EXT STE 210
WATERFORD CT
06385-4332
US

IV. Provider business mailing address

567 VAUXHALL STREET EXT STE 207
WATERFORD CT
06385-4332
US

V. Phone/Fax

Practice location:
  • Phone: 860-813-2798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JULIA WALDRON
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 860-813-2798