Provider Demographics
NPI:1376968206
Name:ENCHANTED THERAPIES, LLC
Entity Type:Organization
Organization Name:ENCHANTED THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-919-7840
Mailing Address - Street 1:112 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1125
Mailing Address - Country:US
Mailing Address - Phone:860-919-7840
Mailing Address - Fax:
Practice Address - Street 1:112 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1125
Practice Address - Country:US
Practice Address - Phone:860-919-7840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-01
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty