Provider Demographics
NPI:1003224866
Name:HEALING JOURNEY
Entity Type:Organization
Organization Name:HEALING JOURNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CAPEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:607-727-7049
Mailing Address - Street 1:85 MAYAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-1316
Mailing Address - Country:US
Mailing Address - Phone:607-727-7049
Mailing Address - Fax:
Practice Address - Street 1:85 MAYAPPLE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-1316
Practice Address - Country:US
Practice Address - Phone:607-727-7049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0078971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00618162Medicaid