=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831904788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A NEW LEEF, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2025
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1095B S MAIN ST
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410-3432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-984-6262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 647 TAMARACK RD
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410-3227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-317-0220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL THERAPIST
-----------------------------------------------------
Name | ANNA ISABEL LEE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 203-317-0220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------