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General NPI Number Information
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NPI Number | 1902257272
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Entity Type | Organization
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Legal Business Name | WELLNESS HAVEN LLC
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 340 WHITNEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06511-2317
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Country | US
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Telephone | 203-980-5822
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Fax |
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Provider Business Mailing Address
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Address Line | 340 WHITNEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06511-2317
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Country | US
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Telephone | 203-980-5822
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST/ MANAGER
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Name | CANDICE PARAGANO
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Credential | L.AC.
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Telephone | 203-980-5822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000572
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License Number State | CT
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