Provider Demographics
NPI:1073964961
Name:SERAPHINA INTEGRATIVE WELLNESS, LLC
Entity Type:Organization
Organization Name:SERAPHINA INTEGRATIVE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:ND, PSYD, LAC
Authorized Official - Phone:203-709-0325
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:710 MAIN STREET SOUTH
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-0772
Mailing Address - Country:US
Mailing Address - Phone:203-709-0325
Mailing Address - Fax:203-405-6972
Practice Address - Street 1:1449 OLD WATERBURY RD
Practice Address - Street 2:SUITE 307 A
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3926
Practice Address - Country:US
Practice Address - Phone:203-709-0325
Practice Address - Fax:203-405-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001965103TC0700X
CT000504171100000X
CT000415175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty