Provider Demographics
NPI:1063021228
Name:CLEAR SKY THERAPY SERVICES
Entity Type:Organization
Organization Name:CLEAR SKY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEQUILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MBA
Authorized Official - Phone:860-458-4759
Mailing Address - Street 1:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-7676
Mailing Address - Country:US
Mailing Address - Phone:860-458-4759
Mailing Address - Fax:504-226-0721
Practice Address - Street 1:68 LYMAN RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1311
Practice Address - Country:US
Practice Address - Phone:860-458-4759
Practice Address - Fax:504-226-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)