=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184962250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORACLE COUNSELING & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2013
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 CHERRY ST STE D
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460-3455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-859-1026
-----------------------------------------------------
Fax | 203-283-7857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 CHERRY ST STE D
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460-3455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-859-1026
-----------------------------------------------------
Fax | 203-283-7857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ LICENSED CLINICAL SOCIAL WOR
-----------------------------------------------------
Name | CHRISTA L. JACARUSO
-----------------------------------------------------
Credential | M.S.W, L.C.S.W
-----------------------------------------------------
Telephone | 203-859-1026
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 005929
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------