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General NPI Number Information
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NPI Number | 1720316581
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Entity Type | Organization
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Legal Business Name | STAYWELL STRESS MANAGEMENT LLC
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Dates
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Enumeration Date | 12/05/2009
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 129 SAMSON ROCK DR UNIT B
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City | MADISON
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State | CT
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Zip | 06443-3034
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Country | US
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Telephone | 203-915-3777
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Fax | 203-909-6621
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Provider Business Mailing Address
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Address Line | 69 REDCOAT LN
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City | GUILFORD
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State | CT
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Zip | 06437-1946
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Country | US
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Telephone | 203-915-3777
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Fax | 203-909-6621
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Authorized Official
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Title or Position | DIRECTOR
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Name | MONICA L. CRETELLA
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Credential | LCSW
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Telephone | 203-915-3777
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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 | 006773
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License Number State | CT
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