Provider Demographics
NPI:1003420829
Name:REGENERATIVE PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:REGENERATIVE PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MERRITT
Authorized Official - Middle Name:
Authorized Official - Last Name:JULIANO
Authorized Official - Suffix:
Authorized Official - Credentials:JD LCSW
Authorized Official - Phone:917-224-9598
Mailing Address - Street 1:95 LONG LOTS RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3919
Mailing Address - Country:US
Mailing Address - Phone:917-224-9598
Mailing Address - Fax:
Practice Address - Street 1:95 LONG LOTS RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3919
Practice Address - Country:US
Practice Address - Phone:917-224-9598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty