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General NPI Number Information
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NPI Number | 1477331064
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Entity Type | Organization
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Legal Business Name | CENTER FOR HEALING TRAUMA LLC
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 840 POST RD E
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City | WESTPORT
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State | CT
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Zip | 06880-5236
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Country | US
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Telephone | 203-383-0501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 86
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City | MONROE
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State | CT
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Zip | 06468-0086
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Country | US
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Telephone | 203-383-0501
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | ELIZABETH MODUGNO
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Credential |
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Telephone | 203-383-0501
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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 |
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License Number State |
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