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General NPI Number Information
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NPI Number | 1871143115
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Entity Type | Organization
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Legal Business Name | SOLID GROUND THERAPY SOLUTIONS LLC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 22 PINE ST STE 103A
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City | BRISTOL
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State | CT
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Zip | 06010-6949
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Country | US
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Telephone | 860-212-3317
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Fax |
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Provider Business Mailing Address
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Address Line | 22 PINE ST STE 103A
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City | BRISTOL
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State | CT
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Zip | 06010-6949
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Country | US
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Telephone | 860-261-7115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSE MARIE BURKE
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Credential | LCSW
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Telephone | 860-212-3317
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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 |
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License Number State |
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