Provider Demographics
NPI:1225366131
Name:THE HEALING CONNECTION, INC.
Entity Type:Organization
Organization Name:THE HEALING CONNECTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PMHCNS-BC
Authorized Official - Phone:585-641-0281
Mailing Address - Street 1:FAIRPORT OFFICE PARK
Mailing Address - Street 2:SUITE 1000D
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2003
Mailing Address - Country:US
Mailing Address - Phone:585-641-0281
Mailing Address - Fax:585-641-0286
Practice Address - Street 1:FAIRPORT OFFICE PARK
Practice Address - Street 2:SUITE 1000D
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2003
Practice Address - Country:US
Practice Address - Phone:585-641-0281
Practice Address - Fax:585-641-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8171001A261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health