Provider Demographics
NPI:1003096744
Name:INTEGRATED WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:INTEGRATED WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKBAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-387-9400
Mailing Address - Street 1:446A BLAKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1286
Mailing Address - Country:US
Mailing Address - Phone:203-387-9400
Mailing Address - Fax:888-772-2160
Practice Address - Street 1:446A BLAKE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-2216
Practice Address - Country:US
Practice Address - Phone:203-387-9400
Practice Address - Fax:888-772-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001636101Y00000X
CT002659103TC2200X
CT0064731041C0700X
CT0054421041C0700X
106H00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty