Healthcare Provider Details

I. General information

NPI: 1235050741
Provider Name (Legal Business Name): LA SALA WELLNESS GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BEAVER RD
WETHERSFIELD CT
06109-2249
US

IV. Provider business mailing address

96 SPRING ST APT 2
MERIDEN CT
06451-5458
US

V. Phone/Fax

Practice location:
  • Phone: 203-679-9641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARISOL CRUZ
Title or Position: OWNER/MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 203-752-7496