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General NPI Number Information
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NPI Number | 1467819375
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Entity Type | Organization
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Legal Business Name | HEALING HEARTS LLC
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 75 BROOK HILL RD
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City | HAMDEN
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State | CT
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Zip | 06514-2001
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Country | US
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Telephone | 203-623-9786
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Fax | 203-745-4215
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Provider Business Mailing Address
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Address Line | PO BOX 9134
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City | NEW HAVEN
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State | CT
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Zip | 06532-0134
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Country | US
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Telephone | 203-623-9786
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Fax | 203-745-4215
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. SHALITA L SAMPSON
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Credential | LCSW
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Telephone | 203-623-9786
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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 | 008810
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License Number State | CT
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