MEDICARE: INFINITY INTEGRATED COUNSELING AND HOLISTIC WELLNESS CENTER LLC.

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1942759733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY INTEGRATED COUNSELING AND HOLISTIC WELLNESS CENTER LLC.

Provider Business Mailing Address
First Line	:	35 TOWER LN
Second Line	:	SUITE 202
City	:	AVON
State	:	CT
Zip	:	06001-4237
Country	:	US
Telephone Number	:	860-404-2736
Fax Number	:	860-470-3988

Provider Business Practice Location Address
First Line	:	35 TOWER LN
Second Line	:	SUITE 202
City	:	AVON
State	:	CT
Zip	:	06001-4237
Country	:	US
Telephone Number	:	860-404-2736
Fax Number	:	860-470-3988

Authorized Official
Title or Position	:	OWNER
Name	:	SORAYA SAWICKI
Credential	:	DSW, LCSW
Telephone Number	:	860-986-1287

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	06/01/2021

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