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General NPI Number Information
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NPI Number | 1982194585
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Entity Type | Organization
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Legal Business Name | WELLNESS AT HOME, LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 254 ENO AVE
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City | TORRINGTON
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State | CT
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Zip | 06790
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Country | US
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Telephone | 860-605-4855
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Fax |
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Provider Business Mailing Address
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Address Line | PAULINE MILLER, MSW, LCSW 254 ENO AVENUE
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City | TORRINGTON
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State | CT
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Zip | 06790
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Country | US
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Telephone | 860-605-4855
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | PAULINE A MILLER
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Credential | LCSW
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Telephone | 860-605-4855
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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 | 004046
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License Number State | CT
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