Provider Demographics
NPI:1083095988
Name:PSYCHOTHERAPY HEALING SERVICES, LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY HEALING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTINGLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-841-7392
Mailing Address - Street 1:3 BARNARD LN
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2452
Mailing Address - Country:US
Mailing Address - Phone:860-586-8700
Mailing Address - Fax:860-236-1909
Practice Address - Street 1:3 BARNARD LN
Practice Address - Street 2:SUITE 310
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2452
Practice Address - Country:US
Practice Address - Phone:860-586-8700
Practice Address - Fax:860-236-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty