Healthcare Provider Details

I. General information

NPI: 1821755653
Provider Name (Legal Business Name): MEADOW SPRINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 OLD RIDGEFIELD RD
WILTON CT
06897-3023
US

IV. Provider business mailing address

1111 STRATFORD AVE APT 114
STRATFORD CT
06615-6370
US

V. Phone/Fax

Practice location:
  • Phone: 203-945-1619
  • Fax: 203-296-1504
Mailing address:
  • Phone: 203-945-1619
  • Fax: 203-296-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ELLEN GALAT
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 203-945-1619