Provider Demographics
NPI:1417516634
Name:CONNECTING HEARTS THERAPY, LLC
Entity Type:Organization
Organization Name:CONNECTING HEARTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE AND FAMILY THERAP
Authorized Official - Prefix:
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-428-3400
Mailing Address - Street 1:542 HOPMEADOW ST STE 305
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-5405
Mailing Address - Country:US
Mailing Address - Phone:860-428-3400
Mailing Address - Fax:
Practice Address - Street 1:542 HOPMEADOW ST STE 305
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-5405
Practice Address - Country:US
Practice Address - Phone:860-428-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1649585068OtherINDIVIDUAL NPI