Healthcare Provider Details

I. General information

NPI: 1588310841
Provider Name (Legal Business Name): SKY MEADOW COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 DEPOT ST. SUITE 202 UNIT D
WATERTOWN CT
06795
US

IV. Provider business mailing address

51 DEPOT ST. SUITE 202 UNIT D
WATERTOWN CT
06795
US

V. Phone/Fax

Practice location:
  • Phone: 203-465-2869
  • Fax:
Mailing address:
  • Phone: 203-465-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN J.C. MCAVOY
Title or Position: MANAGING MEMBER
Credential:
Phone: 203-465-2869