Provider Demographics
NPI:1225487325
Name:AT THE WELL THERAPY
Entity Type:Organization
Organization Name:AT THE WELL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-990-5299
Mailing Address - Street 1:45 S MAIN ST
Mailing Address - Street 2:STE 107
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 S MAIN ST
Practice Address - Street 2:STE 107
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2441
Practice Address - Country:US
Practice Address - Phone:860-990-5299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1851637615OtherNPI