Healthcare Provider Details

I. General information

NPI: 1558929596
Provider Name (Legal Business Name): THE HARMONY CENTER FOR CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 FARMINGTON AVE
WEST HARTFORD CT
06119-1677
US

IV. Provider business mailing address

161 MCCLINTOCK ST
NEW BRITAIN CT
06053-2935
US

V. Phone/Fax

Practice location:
  • Phone: 860-245-1484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BETALLELUZ
Title or Position: LCSW
Credential:
Phone: 860-578-0003