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General NPI Number Information
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NPI Number | 1639965254
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Entity Type | Organization
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Legal Business Name | SOMATIC WOMEN
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 18463 SW 87TH PL
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City | CUTLER BAY
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State | FL
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Zip | 33157-7268
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Country | US
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Telephone | 860-681-5945
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Fax |
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Provider Business Mailing Address
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Address Line | 615 W JOHNSON AVE STE 202
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City | CHESHIRE
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State | CT
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Zip | 06410-4532
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TIFFANY BENTLEY
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Credential | LICSW
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Telephone | 860-681-5945
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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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