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General NPI Number Information
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NPI Number | 1942173786
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Entity Type | Organization
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Legal Business Name | RADICAL CONNECTION LLC
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Dates
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Enumeration Date | 09/26/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 25 GREGORY LN
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City | NORTHAMPTON
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State | MA
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Zip | 01062-3455
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Country | US
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Telephone | 413-281-9245
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Fax |
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Provider Business Mailing Address
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Address Line | 25 GREGORY LN
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City | NORTHAMPTON
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State | MA
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Zip | 01062-3455
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Country | US
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Telephone | 413-281-9245
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | AUDRA TAYLOR WINN
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Credential | LICSW
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Telephone | 413-281-9245
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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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