Healthcare Provider Details

I. General information

NPI: 1033030846
Provider Name (Legal Business Name): THALLO MENTAL HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 RATLEY RD
WEST SUFFIELD CT
06093-2411
US

IV. Provider business mailing address

1036 RATLEY RD
WEST SUFFIELD CT
06093-2411
US

V. Phone/Fax

Practice location:
  • Phone: 860-508-5306
  • Fax:
Mailing address:
  • Phone: 860-508-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARRIE FIJAL
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 860-508-5306