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General NPI Number Information
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NPI Number | 1114456886
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Entity Type | Organization
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Legal Business Name | HAWTHORN HOLISTIC HEALTH LLC
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 06/07/2017
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Provider Practice Location Address
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Address Line | 2969 WHITNEY AVE STE 3B
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City | HAMDEN
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State | CT
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Zip | 06518-2556
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Country | US
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Telephone | 203-903-8624
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Fax |
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Provider Business Mailing Address
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Address Line | 14 JENIFER LN
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City | KILLINGWORTH
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State | CT
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Zip | 06419-1459
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Country | US
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Telephone | 860-759-4119
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. MATTHEW A ROBINSON
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Credential | ND
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Telephone | 860-759-4119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 508
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 503
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License Number State | CT
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