=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134919426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEVATE WELLNESS AND THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 LILLIAN AVE
-----------------------------------------------------
City | THOMPSON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06277-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-499-9072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 LILLIAN AVE
-----------------------------------------------------
City | THOMPSON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06277-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-218-0253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DEBRAH L WHITE
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 508-499-9072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------