Provider Demographics
NPI:1073159372
Name:NEW HAVEN THERAPY, LLC.
Entity Type:Organization
Organization Name:NEW HAVEN THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:267-334-3598
Mailing Address - Street 1:110 WHEELER PATH
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1206
Mailing Address - Country:US
Mailing Address - Phone:267-334-3598
Mailing Address - Fax:
Practice Address - Street 1:625 CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-2168
Practice Address - Country:US
Practice Address - Phone:203-807-4822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA114261120Medicaid