=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306478110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING CONNECTIONS WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2020
-----------------------------------------------------
Last Update Date | 02/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 NEW BRITAIN RD STE C
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06037-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-580-9270
-----------------------------------------------------
Fax | 860-300-3555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 199 AMHERST ST
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06053-2573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-424-7419
-----------------------------------------------------
Fax | 860-300-3555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMANDA LEE MARROTTE
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 860-424-7419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------