MEDICARE: JOURNEY TO SERENITY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1063119089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY TO SERENITY PLLC

Provider Business Mailing Address
First Line	:	34 JEROME AVE STE 304
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2463
Country	:	US
Telephone Number	:	860-471-1225
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 JEROME AVE STE 304
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2463
Country	:	US
Telephone Number	:	860-471-1225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHEVONNE SMITH
Credential	:
Telephone Number	:	860-293-6323

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	06/10/2026

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