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General NPI Number Information
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NPI Number | 1467737965
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Entity Type | Organization
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Legal Business Name | HEALING PASSAGES, LLC
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Dates
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Enumeration Date | 10/15/2011
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Last Update Date | 10/15/2011
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Provider Practice Location Address
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Address Line | 435 BUCKLAND RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3720
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Country | US
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Telephone | 860-249-3272
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Fax |
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Provider Business Mailing Address
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Address Line | 82 MANCHESTER ST
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City | HARTFORD
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State | CT
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Zip | 06112-1454
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Country | US
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Telephone | 860-690-4983
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA M GRANT
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Credential |
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Telephone | 860-249-3272
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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 | 007441
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License Number State | CT
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