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General NPI Number Information
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NPI Number | 1710427851
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Entity Type | Organization
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Legal Business Name | BREAK FREE CENTER FOR WELLNESS
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 642 HILLIARD ST SUITE 1223
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City | MANCHESTER
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State | CT
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Zip | 06042-2700
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Country | US
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Telephone | 860-327-5790
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Fax |
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Provider Business Mailing Address
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Address Line | 130 VERNON AVE APARTMENT 2H
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City | VERNON
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State | CT
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Zip | 06066-3656
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Country | US
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Telephone | 860-881-3076
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MRS. SHARRON YVETTE RILEY-SEYMOUR
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Credential | LPC
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Telephone | 860-881-3076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002815
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License Number State | CT
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