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General NPI Number Information
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NPI Number | 1427849355
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Entity Type | Organization
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Legal Business Name | TRAILHEAD THERAPY LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 06/07/2025
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Provider Practice Location Address
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Address Line | 2389 MAIN ST STE 100
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City | GLASTONBURY
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State | CT
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Zip | 06033-4617
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Country | US
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Telephone | 646-342-4197
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Fax |
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Provider Business Mailing Address
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Address Line | 2389 MAIN ST STE 100
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City | GLASTONBURY
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State | CT
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Zip | 06033-4617
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Country | US
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Telephone | 646-342-4197
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIA WORKER
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Name | MS. RAQUEL MARTINEZ
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Credential | LMSW: LICENSE 2489
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Telephone | 646-342-4197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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