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General NPI Number Information
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NPI Number | 1811425846
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Entity Type | Organization
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Legal Business Name | PROJECT THRIVE CT
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Dates
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Enumeration Date | 06/03/2017
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Last Update Date | 06/03/2017
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Provider Practice Location Address
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Address Line | 682 PROSPECT AVE
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City | HARTFORD
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State | CT
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Zip | 06105-4238
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Country | US
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Telephone | 860-970-8639
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Fax |
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Provider Business Mailing Address
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Address Line | 173 SOMERSET ST # X
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1862
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Country | US
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Telephone | 860-970-8639
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | ALYSSA PIERRE-LOUIS
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Credential | LCSW
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Telephone | 860-970-8639
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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 | 008082
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License Number State | CT
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