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General NPI Number Information
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NPI Number | 1922476837
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Entity Type | Organization
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Legal Business Name | NORTHEAST CENTER FOR HEALING AND WELLNESS
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 270 FARMINGTON AVE SUITE 333
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City | FARMINGTON
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State | CT
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Zip | 06032-1909
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Country | US
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Telephone | 860-255-7750
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Fax | 860-470-3958
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Provider Business Mailing Address
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Address Line | 270 FARMINGTON AVE SUITE 333
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City | FARMINGTON
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State | CT
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Zip | 06032-1909
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Country | US
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Telephone | 860-255-7750
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Fax | 860-470-3958
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | ELLEN GALAT
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Credential | PSY.D.
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Telephone | 860-255-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3429
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License Number State | CT
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