Provider Demographics
NPI:1417690579
Name:HEALING SPACE
Entity Type:Organization
Organization Name:HEALING SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NAVE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-480-0006
Mailing Address - Street 1:123 FARMINGTON AVE STE 156
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4200
Mailing Address - Country:US
Mailing Address - Phone:203-208-8372
Mailing Address - Fax:
Practice Address - Street 1:123 FARMINGTON AVE STE 156
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4200
Practice Address - Country:US
Practice Address - Phone:203-208-8372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty