Provider Demographics
NPI:1346610300
Name:THE YELLOW HOUSE WELLNESS, LLC
Entity Type:Organization
Organization Name:THE YELLOW HOUSE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LICENSED SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUGUSTA
Authorized Official - Middle Name:MATTAR
Authorized Official - Last Name:COLODETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-257-1556
Mailing Address - Street 1:257 SAVOY ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4118
Mailing Address - Country:US
Mailing Address - Phone:203-257-1556
Mailing Address - Fax:
Practice Address - Street 1:257 SAVOY ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4118
Practice Address - Country:US
Practice Address - Phone:203-257-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty