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General NPI Number Information
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NPI Number | 1033624614
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Entity Type | Organization
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Legal Business Name | EMBRACE YOUR PATH, LLC
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 4270 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-2306
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Country | US
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Telephone | 203-301-8852
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Fax | 203-301-8852
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Provider Business Mailing Address
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Address Line | 39 COGSWELL ST
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City | BRIDGEPORT
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State | CT
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Zip | 06610-1913
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Country | US
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Telephone | 203-520-9910
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. DEBORAH SHILLINGFORD
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Credential |
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Telephone | 203-520-9910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007937
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License Number State | CT
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