Healthcare Provider Details

I. General information

NPI: 1902693773
Provider Name (Legal Business Name): TRAUMA TRANSFORMATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 FARMINGTON AVE STE 2C
WEST HARTFORD CT
06119-1672
US

IV. Provider business mailing address

801 FARMINGTON AVE STE 2C
WEST HARTFORD CT
06119-1672
US

V. Phone/Fax

Practice location:
  • Phone: 203-733-9600
  • Fax:
Mailing address:
  • Phone: 203-733-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA PASCIUCCO
Title or Position: OWNER
Credential: PHD, LMFT
Phone: 203-733-9600