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General NPI Number Information
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NPI Number | 1578334033
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Entity Type | Organization
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Legal Business Name | AND THERAPY COLLABORATIVE LLC
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 386 MAIN STREET 4TH AND 5TH FLOORS
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-578-8550
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Fax |
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Provider Business Mailing Address
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Address Line | 386 MAIN STREET 4TH AND 5TH FLOORS
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-578-8550
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CHELSEA POLOSKI
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Credential | LCSW
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Telephone | 860-803-4244
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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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