Provider Demographics
NPI:1275726671
Name:BREATHE,LLC
Entity Type:Organization
Organization Name:BREATHE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILORETO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-796-8003
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06045-1081
Mailing Address - Country:US
Mailing Address - Phone:860-796-8003
Mailing Address - Fax:
Practice Address - Street 1:99 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3907
Practice Address - Country:US
Practice Address - Phone:860-796-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty