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General NPI Number Information
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NPI Number | 1902159528
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Entity Type | Organization
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Legal Business Name | EXHALE BREATHE AND LET GO
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 214 AMITY RD
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2241
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Country | US
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Telephone | 203-589-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 16 BEAVER HILL LN
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City | NEW HAVEN
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State | CT
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Zip | 06511-1639
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Country | US
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Telephone | 203-589-1115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GLADYS JACKSON DEYOUNGE
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Credential | MSW, LCSW
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Telephone | 203-589-1115
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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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