Provider Demographics
NPI:1114586880
Name:SOLACE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:SOLACE PSYCHOTHERAPY LLC
Other - Org Name:SOLACE PSYCHOTHERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-920-8348
Mailing Address - Street 1:44 PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1528
Mailing Address - Country:US
Mailing Address - Phone:860-920-8348
Mailing Address - Fax:860-422-4990
Practice Address - Street 1:682 PROSPECT AVE STE 202
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4238
Practice Address - Country:US
Practice Address - Phone:860-920-8348
Practice Address - Fax:860-422-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008086463Medicaid