Provider Demographics
NPI:1386214864
Name:SPARROWS WORTH WELLNESS SERVICES
Entity Type:Organization
Organization Name:SPARROWS WORTH WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-334-6411
Mailing Address - Street 1:17 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4233
Mailing Address - Country:US
Mailing Address - Phone:860-334-6411
Mailing Address - Fax:
Practice Address - Street 1:17 HICKORY LN
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4233
Practice Address - Country:US
Practice Address - Phone:860-334-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)