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General NPI Number Information
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NPI Number | 1396271532
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Entity Type | Organization
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Legal Business Name | LIVEWELL ALLIANCE, INC.
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Dates
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Enumeration Date | 05/09/2017
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 1261 S MAIN ST
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City | PLANTSVILLE
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State | CT
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Zip | 06479-1750
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Country | US
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Telephone | 860-628-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 1261 S MAIN ST
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City | PLANTSVILLE
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State | CT
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Zip | 06479-1750
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Country | US
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Telephone | 860-628-9000
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Fax |
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Authorized Official
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Title or Position | DIR OF REV & REIMBURSEMENT
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Name | ANYA MARISSE BOUNDS
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Credential |
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Telephone | 860-628-3059
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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 | 009647
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 003405
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License Number State | CT
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