Provider Demographics
NPI:1033624614
Name:EMBRACE YOUR PATH, LLC
Entity Type:Organization
Organization Name:EMBRACE YOUR PATH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILLINGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-520-9910
Mailing Address - Street 1:39 COGSWELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-1913
Mailing Address - Country:US
Mailing Address - Phone:203-520-9910
Mailing Address - Fax:
Practice Address - Street 1:4270 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2306
Practice Address - Country:US
Practice Address - Phone:203-301-8852
Practice Address - Fax:203-301-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1497977375OtherBEHAVIORAL HEALTH