Provider Demographics
NPI:1386217206
Name:CULTIVATING WELLNESS LLC
Entity Type:Organization
Organization Name:CULTIVATING WELLNESS LLC
Other - Org Name:CULTIVATING WELLNESS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-530-7742
Mailing Address - Street 1:112 MADISON STREET
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118
Mailing Address - Country:US
Mailing Address - Phone:860-530-7742
Mailing Address - Fax:
Practice Address - Street 1:112 MADISON STREET
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118
Practice Address - Country:US
Practice Address - Phone:860-530-7742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health