Provider Demographics
NPI:1093101396
Name:THRIVE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:THRIVE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-919-6673
Mailing Address - Street 1:38 NORTHAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1232
Mailing Address - Country:US
Mailing Address - Phone:860-919-6673
Mailing Address - Fax:
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3038
Practice Address - Country:US
Practice Address - Phone:860-919-6673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0080291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1336477363Medicaid