=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003723719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY GENTLE START CT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2026
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 CANAL ST # 29
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-5921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-316-5015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 CANAL ST # 29
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-5921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-316-5015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | RIVKA LAX
-----------------------------------------------------
Credential | DOULA
-----------------------------------------------------
Telephone | 516-316-5015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------