Healthcare Provider Details

I. General information

NPI: 1972423655
Provider Name (Legal Business Name): SMR HOLISTIC PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST STE 204
WEST HARTFORD CT
06107-1941
US

IV. Provider business mailing address

24 GRENHART ST
WEST HARTFORD CT
06117-2105
US

V. Phone/Fax

Practice location:
  • Phone: 860-337-3026
  • Fax:
Mailing address:
  • Phone: 860-337-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SUGEHITLED M RODRIGUEZ
Title or Position: OWNER
Credential: LCSW
Phone: 860-337-3026