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General NPI Number Information
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NPI Number | 1831626811
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR GROWTH AND HEALING, LLC
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 330 S MAIN ST FL 2
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4213
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Country | US
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Telephone | 203-910-3551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28
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City | CHESHIRE
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State | CT
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Zip | 06410-0028
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Country | US
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Telephone | 203-910-3551
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. DEBORAH A. HERELD
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Credential | LCSW
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Telephone | 203-910-3551
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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 | 008788
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License Number State | CT
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