Provider Demographics
NPI:1093378580
Name:BLUESKY WELLNESS, LLC
Entity Type:Organization
Organization Name:BLUESKY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER, PSYCHOTHERA
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TESSIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-296-3002
Mailing Address - Street 1:102 JESSIE DR
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-6530
Mailing Address - Country:US
Mailing Address - Phone:203-883-0440
Mailing Address - Fax:203-883-0440
Practice Address - Street 1:326 W MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2560
Practice Address - Country:US
Practice Address - Phone:203-296-3002
Practice Address - Fax:203-303-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty