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General NPI Number Information
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NPI Number | 1508386350
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Entity Type | Organization
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Legal Business Name | HOLISTIC PSYCHOTHERAPY SERVICES, LLC
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 969 W MAIN ST STE 1D
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City | WATERBURY
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State | CT
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Zip | 06708-2667
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Country | US
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Telephone | 203-768-9808
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Fax | 203-496-5525
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Provider Business Mailing Address
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Address Line | 969 W MAIN ST STE 1D
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City | WATERBURY
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State | CT
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Zip | 06708-2667
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Country | US
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Telephone | 203-768-9808
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Fax | 203-496-5525
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JOSE CREGO
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Credential | LCSW, LADC
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Telephone | 203-768-9808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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